MEDICARE: AUTUMN HOME CARE OF SOUTH WESTERN FLORIDA, 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	299993223	FL

General Provider Information

NPI Number	:	1639335524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTUMN HOME CARE OF SOUTH WESTERN FLORIDA, LLC

Provider Business Mailing Address
First Line	:	10773 70TH AVE
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-6302
Country	:	US
Telephone Number	:	727-398-4467
Fax Number	:	727-399-9788

Provider Business Practice Location Address
First Line	:	4456 TAMIAMI TRL
Second Line	:	SUITE A4
City	:	PUNTA GORDA
State	:	FL
Zip	:	33980-2101
Country	:	US
Telephone Number	:	941-979-5184
Fax Number	:	941-979-5237

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICK AMBROSE
Credential	:	CPA
Telephone Number	:	727-398-4467

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	05/19/2011

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