MEDICARE: REGINA COLEMAN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3747P1801X	Personal Care Attendant
2	374U00000X	Home Health Aide
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1366910853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA COLEMAN

Provider Business Mailing Address
First Line	:	PO BOX 12084
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75607-2084
Country	:	US
Telephone Number	:	903-806-6467
Fax Number	:

Provider Business Practice Location Address
First Line	:	8559 HONEYSUCKLE LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-6830
Country	:	US
Telephone Number	:	903-806-6467
Fax Number	:

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

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	11/02/2018

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Directions to “ REGINA COLEMAN ” Practice Location

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