MEDICARE: BARBARA JEAN COLE

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	310400000X	Assisted Living Facility	148618	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001012285	OTHER	TX	CBA
2	001012024	OTHER	TX	CCAD

General Provider Information

NPI Number	:	1194869636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA JEAN COLE

Provider Business Mailing Address
First Line	:	1364 GILLETTE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-1207
Country	:	US
Telephone Number	:	214-391-8097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1364 GILLETTE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217
Country	:	US
Telephone Number	:	214-391-8097
Fax Number	:

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

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	08/22/2018

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