MEDICARE: RST MED-WAIVER 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1114458650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RST MED-WAIVER INC

Provider Business Mailing Address
First Line	:	306 W KEY AVE
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-4531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 W KEY AVE
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-4531
Country	:	US
Telephone Number	:	352-551-9172
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REGINALD TAYLOR
Credential	:
Telephone Number	:	352-551-9172

Provider Enumeration Date	:	03/26/2017
Last Update Date	:	03/26/2017

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Directions to “RST MED-WAIVER INC ” Practice Location

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