MEDICARE: NATASHA MONEQUE DAVENPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251G00000X	Community Based Hospice Care Agency
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1346566783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA MONEQUE DAVENPORT

Provider Business Mailing Address
First Line	:	1416 ATKINS ST
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-8120
Country	:	US
Telephone Number	:	214-207-0444
Fax Number	:	469-453-3306

Provider Business Practice Location Address
First Line	:	2220 SWANSEE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-1422
Country	:	US
Telephone Number	:	214-207-0444
Fax Number	:	469-453-3306

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

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	06/04/2019

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Directions to “ NATASHA MONEQUE DAVENPORT ” Practice Location

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