MEDICARE: HOUSECALL SUPPORTIVE SERVICES, 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	21172096	FL

General Provider Information

NPI Number	:	1073561288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSECALL SUPPORTIVE SERVICES, LLC

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	:	4210 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5241
Country	:	US
Telephone Number	:	813-962-3083
Fax Number	:	813-962-3825

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONALD LABORDE
Credential	:
Telephone Number	:	225-292-2031

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	03/04/2014

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