MEDICARE: ANAM RESIDENTIAL CARE

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	385H00000X	Respite Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106726	OTHER	TX	PROVIDER IDENTIFICATION NUMBER
2	148822	OTHER	TX	ALF LICENSE

General Provider Information

NPI Number	:	1528540531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANAM RESIDENTIAL CARE

Provider Business Mailing Address
First Line	:	7112 WELSHMAN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6659
Country	:	US
Telephone Number	:	817-690-4848
Fax Number	:

Provider Business Practice Location Address
First Line	:	7112 WELSHMAN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6659
Country	:	US
Telephone Number	:	817-690-4848
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA MINNEWEATHER-RYAN
Credential	:
Telephone Number	:	817-690-4848

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	03/28/2019

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Directions to “ANAM RESIDENTIAL CARE ” Practice Location

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