MEDICARE: CARE PLACEMENT HOME HEALTH AGENCY, 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	253Z00000X	In Home Supportive Care Agency	299992330	FL

General Provider Information

NPI Number	:	1184977076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE PLACEMENT HOME HEALTH AGENCY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 956
Second Line	:
City	:	CRYSTAL BEACH
State	:	FL
Zip	:	34681-0956
Country	:	US
Telephone Number	:	727-787-8677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 12TH ST
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-4014
Country	:	US
Telephone Number	:	727-787-8677
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. RUTH FANOVICH
Credential	:	RN/LHRM
Telephone Number	:	727-787-8677

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	10/17/2012

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