MEDICARE: LBJ HOME HEALTH 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	:	1104763960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LBJ HOME HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1 DR. PAUL TURNER DRIVE
Second Line	:	1 DR. PAUL TURNER DRIVE
City	:	PAGO PAGO
State	:	AS
Zip	:	96799
Country	:	US
Telephone Number	:	684-633-1222
Fax Number	:	808-746-8864

Provider Business Practice Location Address
First Line	:	1 DR. PAUL TURNER DRIVE
Second Line	:	1 DR. PAUL TURNER DRIVE
City	:	PAGO PAGO
State	:	AMERICAN SAMOA
Zip	:	96799
Country	:	UM
Telephone Number	:
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SCOTT ANESI
Credential	:
Telephone Number	:	684-782-6767

Provider Enumeration Date	:	04/30/2026
Last Update Date	:	04/30/2026

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