MEDICARE: GREGORY FRANKLIN

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	14265509	TX

General Provider Information

NPI Number	:	1518381128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY FRANKLIN

Provider Business Mailing Address
First Line	:	604 PRAIRIE GULCH DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-6512
Country	:	US
Telephone Number	:	817-568-1805
Fax Number	:	817-568-1805

Provider Business Practice Location Address
First Line	:	604 PRAIRIE GULCH DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-6512
Country	:	US
Telephone Number	:	817-568-1805
Fax Number	:	817-568-1805

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

Provider Enumeration Date	:	02/18/2014
Last Update Date	:	02/18/2014

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