MEDICARE: MEDERI CARETENDERS VS OF BROWARD, 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	:	1487835294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDERI CARETENDERS VS OF BROWARD, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	337-233-1307
Fax Number	:	337-233-5764

Provider Business Practice Location Address
First Line	:	4901 NW 17TH WAY STE 302A
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3772
Country	:	US
Telephone Number	:	954-484-4837
Fax Number	:	954-484-6272

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONALD STELLY
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	01/21/2019

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