MEDICARE: HEALTHMASTERS HOMECARE, INC

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	007753	TX

General Provider Information

NPI Number	:	1962531194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHMASTERS HOMECARE, INC

Provider Business Mailing Address
First Line	:	2932 HEMPHILL ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76110-6501
Country	:	US
Telephone Number	:	817-927-9550
Fax Number	:	817-927-9558

Provider Business Practice Location Address
First Line	:	2932 HEMPHILL ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76110-6501
Country	:	US
Telephone Number	:	817-927-9550
Fax Number	:	817-927-9558

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JUDITH J WICKSON
Credential	:	RN, CHTP
Telephone Number	:	817-927-9550

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	11/06/2007

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