MEDICARE: MEDERI CARETENDERS VS OF BROWARD, 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

General Provider Information

NPI Number	:	1255599114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDERI CARETENDERS VS OF BROWARD, LLC

Provider Business Mailing Address
First Line	:	9510 ORMSBY STATION RD
Second Line	:	SUITE 300
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4081
Country	:	US
Telephone Number	:	502-891-1000
Fax Number	:	502-891-8067

Provider Business Practice Location Address
First Line	:	824 US HIGHWAY 1
Second Line	:	SUITE 360
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3873
Country	:	US
Telephone Number	:	561-622-3129
Fax Number	:	561-624-1074

Authorized Official
Title or Position	:	SR VP ADMINISTRATION
Name	:	MR. PATRICK T LYLES
Credential	:
Telephone Number	:	502-891-1044

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	09/09/2008

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