MEDICARE: HOME COMPANIONS OF LAKE CO., 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	299992225	FL

General Provider Information

NPI Number	:	1063716975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME COMPANIONS OF LAKE CO., INC

Provider Business Mailing Address
First Line	:	PO BOX 148
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-0148
Country	:	US
Telephone Number	:	352-483-3086
Fax Number	:	352-483-3136

Provider Business Practice Location Address
First Line	:	2785 S BAY ST STE D
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-6591
Country	:	US
Telephone Number	:	352-483-3086
Fax Number	:	352-483-3136

Authorized Official
Title or Position	:	ACCOUNTS MANAGER
Name	:	MS. AVIE LEE KEITH
Credential	:
Telephone Number	:	352-483-3086

Provider Enumeration Date	:	01/06/2011
Last Update Date	:	01/06/2011

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