MEDICARE: SPYGLASS HOME 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	:	1164778965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPYGLASS HOME SERVICES, LLC

Provider Business Mailing Address
First Line	:	8709 STONEBRIAR LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2537
Country	:	US
Telephone Number	:	817-925-4222
Fax Number	:	817-263-9751

Provider Business Practice Location Address
First Line	:	8709 STONEBRIAR LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2537
Country	:	US
Telephone Number	:	817-925-4222
Fax Number	:	817-263-9751

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	SANDRA K JONES
Credential	:
Telephone Number	:	817-925-4222

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	07/30/2012

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