MEDICARE: HIBISCUS HEALTH CARE SERVICES LLC

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		FL

General Provider Information

NPI Number	:	1144565664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIBISCUS HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	14335 SW 120TH ST
Second Line	:	SUITE 206
City	:	MIAMI
State	:	FL
Zip	:	33186-7294
Country	:	US
Telephone Number	:	305-752-0340
Fax Number	:	205-752-0360

Provider Business Practice Location Address
First Line	:	14335 SW 120TH ST
Second Line	:	SUITE 206
City	:	MIAMI
State	:	FL
Zip	:	33186-7294
Country	:	US
Telephone Number	:	305-752-0340
Fax Number	:	205-752-0360

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS LISA VAZQUEZ
Credential	:
Telephone Number	:	305-467-6832

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	12/10/2012

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