MEDICARE: COALESCENT CARE

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

General Provider Information

NPI Number	:	1942682778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COALESCENT CARE

Provider Business Mailing Address
First Line	:	14200 THE LAKES BLVD
Second Line	:	APT. 921
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-3777
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 FAWN RIDGE RD
Second Line	:
City	:	CEDAR CREEK
State	:	TX
Zip	:	78612-3491
Country	:	US
Telephone Number	:	512-718-4014
Fax Number	:

Authorized Official
Title or Position	:	CAREGIVER
Name	:	LACEY MILLER
Credential	:
Telephone Number	:	512-718-4014

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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Directions to “COALESCENT CARE ” Practice Location

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