MEDICARE: SOUTHWEST HOME CARE, 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	251E00000X	Home Health Agency	7001344	TX

General Provider Information

NPI Number	:	1558307074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST HOME CARE, LLC

Provider Business Mailing Address
First Line	:	2921 LACKLAND RD
Second Line	:	SUITE #202
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4173
Country	:	US
Telephone Number	:	817-738-0008
Fax Number	:	817-738-7338

Provider Business Practice Location Address
First Line	:	2921 LACKLAND RD
Second Line	:	SUITE #202
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4173
Country	:	US
Telephone Number	:	817-738-0008
Fax Number	:	817-738-7338

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	KRISHA R SCHARNWEBER
Credential	:
Telephone Number	:	817-738-0008

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/03/2007

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