MEDICARE: VONSETTA SAVAGE

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1104467380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VONSETTA SAVAGE

Provider Business Mailing Address
First Line	:	5708 NORRIS ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-1706
Country	:	US
Telephone Number	:	682-558-0312
Fax Number	:

Provider Business Practice Location Address
First Line	:	7224 MARTHA LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-5347
Country	:	US
Telephone Number	:	682-558-0312
Fax Number	:

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

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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Directions to “ VONSETTA SAVAGE ” Practice Location

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