MEDICARE: PBAJ ENTERPRISES, 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	231752	FL

General Provider Information

NPI Number	:	1235450875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PBAJ ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	608 SE 29TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-3527
Country	:	US
Telephone Number	:	239-458-9423
Fax Number	:	239-471-7914

Provider Business Practice Location Address
First Line	:	1406 SE 46TH LN
Second Line	:	SUITE 6
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8684
Country	:	US
Telephone Number	:	239-471-7920
Fax Number	:	239-471-7914

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BARRY CONNOR
Credential	:
Telephone Number	:	239-333-9883

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/17/2010

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