MEDICARE: WESTSIDE CAREGIVERS, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32056914545	OTHER	TX	TEXAS TAXPAYER NUMBER

General Provider Information

NPI Number	:	1275920159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE CAREGIVERS, LLC

Provider Business Mailing Address
First Line	:	118 BEAR PATH TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76126-9691
Country	:	US
Telephone Number	:	817-991-7253
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 W EL PASO ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5907
Country	:	US
Telephone Number	:	817-560-3975
Fax Number	:	866-931-1601

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. KAREN DELL WILLIAMS
Credential	:	RN
Telephone Number	:	817-991-7253

Provider Enumeration Date	:	04/18/2015
Last Update Date	:	04/18/2019

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Directions to “WESTSIDE CAREGIVERS, LLC ” Practice Location

Language	Start Address	Practice Location

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