MEDICARE: MDS HEALTHCARE SERVICES, LLC

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	:	1053668251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDS HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	13256 BLUE JEAN DR
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-4857
Country	:	US
Telephone Number	:	817-919-3895
Fax Number	:

Provider Business Practice Location Address
First Line	:	13256 BLUE JEAN DR
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-4857
Country	:	US
Telephone Number	:	817-919-3895
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	STEPHANIE SHEDD
Credential	:
Telephone Number	:	817-919-3895

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	11/16/2012

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