MEDICARE: GLORIA JEAN FLENNOY

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	:	1932607512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORIA JEAN FLENNOY

Provider Business Mailing Address
First Line	:	4804 ALANDALE DR
Second Line	:
City	:	FOREST HILL
State	:	TX
Zip	:	76119-7508
Country	:	US
Telephone Number	:	682-302-4267
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 BOULEVARD 26 STE E
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76180-8656
Country	:	US
Telephone Number	:	682-302-4267
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GLORIA FLENNOY
Credential	:
Telephone Number	:	682-302-4267

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	03/17/2018

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