MEDICARE: HOUSECALL HOME HEALTH, 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	251E00000X	Home Health Agency	210100961	FL

General Provider Information

NPI Number	:	1255389664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSECALL HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-292-2031
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	9200 NW 39TH AVE
Second Line	:	SUITE 190
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-7331
Country	:	US
Telephone Number	:	352-372-0466
Fax Number	:	352-372-0824

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONALD LABORDE
Credential	:
Telephone Number	:	225-292-2031

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	03/06/2014

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