MEDICARE: EMINENCE CONSULTING GROUP

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1831949577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMINENCE CONSULTING GROUP

Provider Business Mailing Address
First Line	:	5679 WILD ACRES
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2728
Country	:	US
Telephone Number	:	682-408-3318
Fax Number	:

Provider Business Practice Location Address
First Line	:	5679 WILD ACRES
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2728
Country	:	US
Telephone Number	:	682-408-3318
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	BRENDA KAYE TOLLIVER
Credential	:
Telephone Number	:	682-408-3318

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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Directions to “EMINENCE CONSULTING GROUP ” Practice Location

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