MEDICARE: FORTRESS HOME HEALTHCARE AGENCY

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	320700000X	Physical Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1376717876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTRESS HOME HEALTHCARE AGENCY

Provider Business Mailing Address
First Line	:	7502 GREENVILLE AVE STE 500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7502 GREENVILLE AVE STE 500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3812
Country	:	US
Telephone Number	:	214-890-4029
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	JANET NAMASAKA
Credential	:	RN
Telephone Number	:	214-994-3365

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2008

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