MEDICARE: OUR CARE HOME ASSISTED LIVING, 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	310400000X	Assisted Living Facility	AL11057	FL

General Provider Information

NPI Number	:	1386873230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR CARE HOME ASSISTED LIVING, INC

Provider Business Mailing Address
First Line	:	9043 NW 13TH CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6636
Country	:	US
Telephone Number	:	954-752-0128
Fax Number	:	954-752-7208

Provider Business Practice Location Address
First Line	:	9043 NW 13TH CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6636
Country	:	US
Telephone Number	:	954-752-0128
Fax Number	:	954-752-7208

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS VERONICA O'CONNOR
Credential	:	P.A.
Telephone Number	:	954-592-9239

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	07/13/2009

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