MEDICARE: LIL' MAMA'S TOTAL CARE SERVICE

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		FL
2	171W00000X	Contractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447239991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIL' MAMA'S TOTAL CARE SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 26846
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-6846
Country	:	US
Telephone Number	:	904-228-7761
Fax Number	:	866-612-3472

Provider Business Practice Location Address
First Line	:	3955 WINDY GALE DR N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4423
Country	:	US
Telephone Number	:	904-228-7761
Fax Number	:	866-612-3472

Authorized Official
Title or Position	:	REGIONAL MANAGER/OWNER
Name	:	YOLANDA DENISE AUSTIN-JAMES
Credential	:
Telephone Number	:	904-228-7761

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	09/29/2011

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