MEDICARE: ABSOLUTE CARE FOSTER HOME

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	08-03786	TX

General Provider Information

NPI Number	:	1649422247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE CARE FOSTER HOME

Provider Business Mailing Address
First Line	:	1821 ED WHITE WAY
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5538
Country	:	US
Telephone Number	:	915-921-0139
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 ED WHITE WAY
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5538
Country	:	US
Telephone Number	:	915-921-0139
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAXINE ANGELLA BAILEY
Credential	:
Telephone Number	:	915-921-0139

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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