MEDICARE: INTERIM HEALTHCARE OF NW FL 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		FL

General Provider Information

NPI Number	:	1760454342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERIM HEALTHCARE OF NW FL INC

Provider Business Mailing Address
First Line	:	1962 VILLAGE GREEN WAY
Second Line	:	SUITE B
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-3800
Country	:	US
Telephone Number	:	850-422-2044
Fax Number	:	850-386-6985

Provider Business Practice Location Address
First Line	:	1962 VILLAGE GREEN WAY
Second Line	:	SUITE B
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-3800
Country	:	US
Telephone Number	:	850-422-2044
Fax Number	:	850-386-6985

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. ROBERT G GAFF
Credential	:	PRESIDENT
Telephone Number	:	850-422-2044

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	01/08/2008

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