MEDICARE: KELLI A. FOX

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1124205067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLI A. FOX

Provider Business Mailing Address
First Line	:	1230 W BALBOA BLVD
Second Line	:	#E
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92661-1061
Country	:	US
Telephone Number	:	801-451-9020
Fax Number	:	866-299-5156

Provider Business Practice Location Address
First Line	:	1230 W BALBOA BLVD
Second Line	:	#E
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92661-1061
Country	:	US
Telephone Number	:	801-451-9020
Fax Number	:	866-299-5156

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. KELLI ANN FOX
Credential	:
Telephone Number	:	801-451-9020

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	07/10/2008

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