MEDICARE: QUALICARE 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	PN13016288	FL

General Provider Information

NPI Number	:	1528259066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALICARE HEALTH INC

Provider Business Mailing Address
First Line	:	12620 BEACH BLVD
Second Line	:	143
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12620 BEACH BLVD
Second Line	:	143
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7131
Country	:	US
Telephone Number	:	904-827-9099
Fax Number	:	904-827-9093

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN ALEN SUTTON
Credential	:
Telephone Number	:	904-233-8404

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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