MEDICARE: S & S HEALTH CARE, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	112240	OTHER	VA	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154371144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S & S HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	2747 PENN FOREST BLVD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-4342
Country	:	US
Telephone Number	:	540-774-8686
Fax Number	:	540-774-0279

Provider Business Practice Location Address
First Line	:	3235 VIRGINIA AVE
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-2241
Country	:	US
Telephone Number	:	276-647-1700
Fax Number	:	276-647-4990

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	JEFFREY LYNN PETESEN
Credential	:
Telephone Number	:	540-774-8686

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	06/04/2010

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Directions to “S & S HEALTH CARE, INC. ” Practice Location

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