MEDICARE: SHEKINAH GLORY HOMEMAKER/COMPANION AGENCY 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	372600000X	Adult Companion	233449	FL
2	376J00000X	Homemaker	233449	FL

General Provider Information

NPI Number	:	1154745057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEKINAH GLORY HOMEMAKER/COMPANION AGENCY INC

Provider Business Mailing Address
First Line	:	1828 PALMDALE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-2309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 PALMDALE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-2309
Country	:	US
Telephone Number	:	239-288-4857
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MRS. OZELLA WARD
Credential	:
Telephone Number	:	239-288-4857

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/12/2014

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