MEDICARE: VEDOORN 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	009777	TX

General Provider Information

NPI Number	:	1194041418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEDOORN INC.

Provider Business Mailing Address
First Line	:	2216 N RIVER HILLS RD APT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78733-2146
Country	:	US
Telephone Number	:	512-402-1119
Fax Number	:	512-263-9104

Provider Business Practice Location Address
First Line	:	2216 N RIVER HILLS RD APT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78733-2146
Country	:	US
Telephone Number	:	512-402-1119
Fax Number	:	512-263-9104

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JACKIE VERDOORN
Credential	:
Telephone Number	:	512-402-1119

Provider Enumeration Date	:	04/12/2010
Last Update Date	:	06/29/2016

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