MEDICARE: ANN MONTGOMERY VENTURES, LLC

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	253Z00000X	In Home Supportive Care Agency	PENDING	FL

General Provider Information

NPI Number	:	1063724342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN MONTGOMERY VENTURES, LLC

Provider Business Mailing Address
First Line	:	13611 MCGREGOR BLVD STE 8
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-6042
Country	:	US
Telephone Number	:	239-689-4676
Fax Number	:	239-362-0982

Provider Business Practice Location Address
First Line	:	13611 MCGREGOR BLVD STE 8
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-6042
Country	:	US
Telephone Number	:	239-689-4676
Fax Number	:	239-362-0982

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANN MONTGOMERY
Credential	:
Telephone Number	:	239-689-4676

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	07/02/2010

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