MEDICARE: ENTRUST CARE HOME, 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

General Provider Information

NPI Number	:	1538609318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTRUST CARE HOME, LLC

Provider Business Mailing Address
First Line	:	9112 NIGHTINGALE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2712
Country	:	US
Telephone Number	:	817-808-3218
Fax Number	:

Provider Business Practice Location Address
First Line	:	9112 NIGHTINGALE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2712
Country	:	US
Telephone Number	:	817-808-3218
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PAULA RENEE LANDRY
Credential	:
Telephone Number	:	817-808-3218

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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