MEDICARE: A FRIENDLY NEIGHBOR HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1649706722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A FRIENDLY NEIGHBOR HOME CARE LLC

Provider Business Mailing Address
First Line	:	4500 MERCANTILE PLAZA DR STE 300
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137-4206
Country	:	US
Telephone Number	:	816-255-7920
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 MERCANTILE PLAZA DR STE 300
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137-4206
Country	:	US
Telephone Number	:	816-255-7920
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAUNTA PARKER
Credential	:
Telephone Number	:	816-255-7920

Provider Enumeration Date	:	05/10/2017
Last Update Date	:	04/26/2018

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