MEDICARE: CAROL RODRIGUEZ

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

General Provider Information

NPI Number	:	1265980015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL RODRIGUEZ

Provider Business Mailing Address
First Line	:	5270 EGNER ST
Second Line	:
City	:	SAND LAKE
State	:	MI
Zip	:	49343-8859
Country	:	US
Telephone Number	:	616-696-8411
Fax Number	:

Provider Business Practice Location Address
First Line	:	5270 EGNER ST
Second Line	:
City	:	SAND LAKE
State	:	MI
Zip	:	49343-8859
Country	:	US
Telephone Number	:	616-696-8411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	09/21/2016

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Directions to “ CAROL RODRIGUEZ ” Practice Location

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