MEDICARE: MS. CHARLES ANN KEY CARE SERVICES

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	253Z00000X	In Home Supportive Care Agency	236764	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	236764	OTHER	FL	HOME SUPPORTIVE SERVICES

General Provider Information

NPI Number	:	1093444234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARLES ANN KEY CARE SERVICES

Provider Business Mailing Address
First Line	:	1541 BALFOUR POINT DR APT B
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1922
Country	:	US
Telephone Number	:	561-722-5199
Fax Number	:	561-720-2921

Provider Business Practice Location Address
First Line	:	801 NORTHPOINT PKWY STE 66
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1994
Country	:	US
Telephone Number	:	561-722-5199
Fax Number	:	561-720-2921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2022
Last Update Date	:	06/05/2022

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