=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255785143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A&I HOME CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2016
-----------------------------------------------------
Last Update Date | 06/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4066 EVANS AVE STE 18
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33901-9396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-939-0073
-----------------------------------------------------
Fax | 239-939-0023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1784 N MARKLEY CT
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33916-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-822-8759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. ANNETTA ISHMAEL
-----------------------------------------------------
Credential | HHA
-----------------------------------------------------
Telephone | 239-822-8759
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 234376
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------