MEDICARE: MELCARE HOME HEALTH AND SPORT 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	283X00000X	Rehabilitation Hospital
2	320700000X	Physical Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1033540612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELCARE HOME HEALTH AND SPORT CARE

Provider Business Mailing Address
First Line	:	4020 N MACARTHUR BLVD
Second Line	:	STE #122-194
City	:	IRVING
State	:	TX
Zip	:	75038-6419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 N MACARTHUR BLVD
Second Line	:	STE #122-194
City	:	IRVING
State	:	TX
Zip	:	75038-6419
Country	:	US
Telephone Number	:	855-225-2286
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. KRIT KAEWCHAY
Credential	:
Telephone Number	:	855-225-2286

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	12/09/2013

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