MEDICARE: VIRTUE OF HOPE HEALTHCARE SERVICES

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

General Provider Information

NPI Number	:	1881926640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUE OF HOPE HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	4703 EAST LANCASTER AVE.
Second Line	:	SUITE B
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3836
Country	:	US
Telephone Number	:	817-353-6500
Fax Number	:	817-413-6060

Provider Business Practice Location Address
First Line	:	4704 E LANCASTER AVE
Second Line	:	SUITE B
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3836
Country	:	US
Telephone Number	:	817-353-6500
Fax Number	:	817-413-6060

Authorized Official
Title or Position	:	RN/DIRECTOR OF CLINICAL SERVICES
Name	:	MR. ANTHONY LAVA FAJARDO
Credential	:
Telephone Number	:	817-353-6500

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	02/04/2010

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