MEDICARE: MRS. LEONARDTINE Y COLLINS

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	311ZA0620X	Adult Care Home Facility		TX

General Provider Information

NPI Number	:	1518802750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEONARDTINE Y COLLINS

Provider Business Mailing Address
First Line	:	2405 EDINBURGH DR
Second Line	:
City	:	CROWLEY
State	:	TX
Zip	:	76036-4667
Country	:	US
Telephone Number	:	817-902-8656
Fax Number	:

Provider Business Practice Location Address
First Line	:	8509 PRAIRIE ROSE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2363
Country	:	US
Telephone Number	:	817-902-8656
Fax Number	:

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

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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