MEDICARE: R A HOME LIFE SERVICES 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	261QD1600X	Developmental Disabilities Clinic/Center

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	:	1508371477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R A HOME LIFE SERVICES INC

Provider Business Mailing Address
First Line	:	2002 42ND PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-1518
Country	:	US
Telephone Number	:	772-617-2804
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 42ND PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-1518
Country	:	US
Telephone Number	:	772-617-2804
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AVRIL FLEMMING
Credential	:
Telephone Number	:	772-671-2804

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	12/13/2017

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Directions to “R A HOME LIFE SERVICES INC ” Practice Location

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