MEDICARE: ANASTASIAS HOME HEALTH CARE 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	:	1932630548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANASTASIAS HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	3117 SEDONA TRL
Second Line	:	3117 SEDONA TRAIL
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-8442
Country	:	US
Telephone Number	:	904-930-6933
Fax Number	:

Provider Business Practice Location Address
First Line	:	7336 WILDER AVE
Second Line	:	7336 WILDER AVE
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-4270
Country	:	US
Telephone Number	:	904-930-6933
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANASTASIA M DEGRAFFREAD
Credential	:
Telephone Number	:	904-930-6933

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	03/24/2017

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