MEDICARE: FRANKINCENSE ENTERPRISES, 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	253Z00000X	In Home Supportive Care Agency	L000000015573	TN

General Provider Information

NPI Number	:	1386013134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANKINCENSE ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	6218 RINGGOLD RD
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37412-3849
Country	:	US
Telephone Number	:	423-424-0944
Fax Number	:	423-650-4743

Provider Business Practice Location Address
First Line	:	6218 RINGGOLD RD
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37412-3849
Country	:	US
Telephone Number	:	423-424-0944
Fax Number	:	423-650-4743

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JAMES THOMAS FRANK
Credential	:
Telephone Number	:	407-417-7424

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	09/23/2015

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