MEDICARE: ROSEWAYNE HEALTH SERVICES & HOME CARE

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	251J00000X	Nursing Care Agency	30211448	FL

General Provider Information

NPI Number	:	1114357787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEWAYNE HEALTH SERVICES & HOME CARE

Provider Business Mailing Address
First Line	:	6239 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4736
Country	:	US
Telephone Number	:	407-373-9605
Fax Number	:	321-206-9704

Provider Business Practice Location Address
First Line	:	6239 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4736
Country	:	US
Telephone Number	:	407-373-9605
Fax Number	:	321-206-9704

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ENTROSE PEART
Credential	:
Telephone Number	:	407-373-9605

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	11/19/2013

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