MEDICARE: MILESTONE GERIATRIC DAY CARE, INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1184671752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILESTONE GERIATRIC DAY CARE, INC

Provider Business Mailing Address
First Line	:	2516 OAKLAND BLVD
Second Line	:	SUITE 3
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3203
Country	:	US
Telephone Number	:	817-429-2290
Fax Number	:	817-451-8114

Provider Business Practice Location Address
First Line	:	2516 OAKLAND BLVD
Second Line	:	SUITE 3
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3203
Country	:	US
Telephone Number	:	817-429-2290
Fax Number	:	817-451-8114

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MISS AUDREY LUEEL IRVING
Credential	:	N/A
Telephone Number	:	817-429-2290

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	11/02/2007

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Directions to “MILESTONE GERIATRIC DAY CARE, INC ” Practice Location

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