MEDICARE: YESHUA CATERING MINISTRY

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	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1053122176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YESHUA CATERING MINISTRY

Provider Business Mailing Address
First Line	:	9353 LEGACY CREEK TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-6132
Country	:	US
Telephone Number	:	904-788-2377
Fax Number	:

Provider Business Practice Location Address
First Line	:	9353 LEGACY CREEK TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-6132
Country	:	US
Telephone Number	:	904-788-2377
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NAKIESHA GIDEON
Credential	:
Telephone Number	:	904-788-2377

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	06/30/2026

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Directions to “YESHUA CATERING MINISTRY ” Practice Location

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