MEDICARE: MS. JADESOLA ATOMRE

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1881822013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JADESOLA ATOMRE

Provider Business Mailing Address
First Line	:	8128 ROYAL TERRACE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-5074
Country	:	US
Telephone Number	:	757-372-0417
Fax Number	:	817-275-7739

Provider Business Practice Location Address
First Line	:	8128 ROYAL TERRACE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-5074
Country	:	US
Telephone Number	:	757-372-0417
Fax Number	:	817-275-7739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	06/25/2009

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