MEDICARE: JERRY HOME HEALTH, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1457653420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERRY HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	8550 W FLAGLER ST
Second Line	:	SUITE 116
City	:	MIAMI
State	:	FL
Zip	:	33144-2037
Country	:	US
Telephone Number	:	407-850-4060
Fax Number	:

Provider Business Practice Location Address
First Line	:	12701 S JOHN YOUNG PKWY
Second Line	:	SUITE 202
City	:	ORLANDO
State	:	FL
Zip	:	32837-3420
Country	:	US
Telephone Number	:	407-850-4060
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JULIO ARMANDO BRUNET
Credential	:
Telephone Number	:	407-850-4060

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	11/24/2010

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