MEDICARE: ISLAND NURSING SERVICES, 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

General Provider Information

NPI Number	:	1790138931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND NURSING SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 10071
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32006-0039
Country	:	US
Telephone Number	:	904-571-4777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 LAKE POINT PL
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-7243
Country	:	US
Telephone Number	:	904-571-4777
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE ALLAIRE
Credential	:
Telephone Number	:	904-571-4777

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	07/22/2016

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