MEDICARE: MEDHEALTH NURSING, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D3982767	OTHER	CA	DRIVER'S LICENSE

General Provider Information

NPI Number	:	1588788095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDHEALTH NURSING, LLC

Provider Business Mailing Address
First Line	:	340 LAKE MERCED BLVD APT 21
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-3124
Country	:	US
Telephone Number	:	510-512-8289
Fax Number	:	650-994-5320

Provider Business Practice Location Address
First Line	:	340 LAKE MERCED BLVD APT 21
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-3124
Country	:	US
Telephone Number	:	510-512-8289
Fax Number	:	650-994-5320

Authorized Official
Title or Position	:	ADM/DIR. PATIENT CARE SERVICES
Name	:	MRS. CARMELITA CEA MALLARI
Credential	:	MD, BSN, RN
Telephone Number	:	510-512-8289

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	09/09/2010

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Directions to “MEDHEALTH NURSING, LLC ” Practice Location

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