MEDICARE: HOUSECALL SUPPORTIVE SERVICES, INC.

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	213280962	FL

General Provider Information

NPI Number	:	1043268246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSECALL SUPPORTIVE SERVICES, INC.

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-292-2031
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	12601 NEW BRITTANY BLVD
Second Line	:	BUILDING 19
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3631
Country	:	US
Telephone Number	:	239-274-0664
Fax Number	:	239-275-3208

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM BORNE
Credential	:
Telephone Number	:	225-292-2031

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	10/07/2010

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