MEDICARE: SEQUIN HOMECARE SERVICES 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	:	1437675774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEQUIN HOMECARE SERVICES LLC

Provider Business Mailing Address
First Line	:	110 PLANTATION DR
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-6129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 PLANTATION DR
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-6129
Country	:	US
Telephone Number	:	979-297-3802
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHUNTA DAILEY
Credential	:
Telephone Number	:	979-297-3802

Provider Enumeration Date	:	08/18/2017
Last Update Date	:	08/18/2017

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