MEDICARE: CLINTRICIA BAKER

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	:	1306207725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINTRICIA BAKER

Provider Business Mailing Address
First Line	:	PO BOX 153107
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75315-3107
Country	:	US
Telephone Number	:	214-915-9936
Fax Number	:	972-587-7105

Provider Business Practice Location Address
First Line	:	4907 SPRING AVENUE
Second Line	:	SUITE 201
City	:	DALLAS
State	:	TX
Zip	:	75210-1360
Country	:	US
Telephone Number	:	972-370-6773
Fax Number	:	972-587-7105

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

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	08/08/2017

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Directions to “ CLINTRICIA BAKER ” Practice Location

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