MEDICARE: UNIVERSAL STAFFING, INC.

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	253Z00000X	In Home Supportive Care Agency		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	006848	OTHER	TX	TEXAS DEPARTMENT OF AGING AND DISABILITY

General Provider Information

NPI Number	:	1700165123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL STAFFING, INC.

Provider Business Mailing Address
First Line	:	1208 COUNTRY CLUB LANE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-2353
Country	:	US
Telephone Number	:	817-451-1404
Fax Number	:	817-451-5029

Provider Business Practice Location Address
First Line	:	1208 COUNTRY CLUB LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-2353
Country	:	US
Telephone Number	:	817-451-1404
Fax Number	:	817-451-5029

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KATHY DIANE WALLS
Credential	:	RN
Telephone Number	:	817-451-1404

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	08/16/2011

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Directions to “UNIVERSAL STAFFING, INC. ” Practice Location

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