MEDICARE: HANSON SERVICES #5 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	NR30211234	FL

General Provider Information

NPI Number	:	1104079565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANSON SERVICES #5 INC.

Provider Business Mailing Address
First Line	:	14600 DETROIT AVE STE 420
Second Line	:	P.O. BOX 771222
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4299
Country	:	US
Telephone Number	:	216-226-5425
Fax Number	:	216-226-5623

Provider Business Practice Location Address
First Line	:	13571 MCGREGOR BLVD
Second Line	:	SUITE 26
City	:	FORT MYERS
State	:	FL
Zip	:	33919-6057
Country	:	US
Telephone Number	:	239-433-0230
Fax Number	:	239-437-7111

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ANNA LEININGER
Credential	:
Telephone Number	:	239-433-0230

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/30/2008

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