MEDICARE: LONNIE WOODS

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	75-2515490	TX

General Provider Information

NPI Number	:	1619305612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONNIE WOODS

Provider Business Mailing Address
First Line	:	914 BELCLAIRE CIR
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-1238
Country	:	US
Telephone Number	:	214-277-9516
Fax Number	:	972-291-0032

Provider Business Practice Location Address
First Line	:	5025 E BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-2239
Country	:	US
Telephone Number	:	217-277-9516
Fax Number	:	214-277-9516

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

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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Directions to “ LONNIE WOODS ” Practice Location

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