MEDICARE: MEDLINE HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	251S00000X	Community/Behavioral Health Agency
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1649570706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDLINE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	4542 LONG CREEK DR
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-6064
Country	:	US
Telephone Number	:	832-877-3806
Fax Number	:

Provider Business Practice Location Address
First Line	:	4542 LONG CREEK DR
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-6064
Country	:	US
Telephone Number	:	832-877-3806
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. KENNETH N UKAH
Credential	:
Telephone Number	:	832-877-3806

Provider Enumeration Date	:	10/23/2010
Last Update Date	:	10/26/2010

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Directions to “MEDLINE HEALTH SERVICES ” Practice Location

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