MEDICARE: MARY SEACOLE HEALTHCARE

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	230207	FL

General Provider Information

NPI Number	:	1558534628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY SEACOLE HEALTHCARE

Provider Business Mailing Address
First Line	:	4321 ROCK ISLAND RD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-4527
Country	:	US
Telephone Number	:	954-964-7674
Fax Number	:	954-636-2079

Provider Business Practice Location Address
First Line	:	4321 ROCK ISLAND RD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-4527
Country	:	US
Telephone Number	:	954-964-7674
Fax Number	:	954-636-2079

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. AZRA DAWES
Credential	:
Telephone Number	:	954-964-7674

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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Directions to “MARY SEACOLE HEALTHCARE ” Practice Location

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