MEDICARE: MD HOME CARE

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	310400000X	Assisted Living Facility	AL10585	FL

General Provider Information

NPI Number	:	1922283803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD HOME CARE

Provider Business Mailing Address
First Line	:	4857 NW 168TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-4272
Country	:	US
Telephone Number	:	305-430-0775
Fax Number	:

Provider Business Practice Location Address
First Line	:	4857 NW 168TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-4272
Country	:	US
Telephone Number	:	305-430-0775
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MADELEIN CANCELA DIAZ
Credential	:
Telephone Number	:	786-213-4662

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	01/09/2008

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