MEDICARE: LHC SKILLED CORP.

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	299994176	FL

General Provider Information

NPI Number	:	1164857306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LHC SKILLED CORP.

Provider Business Mailing Address
First Line	:	2975B W COMMERCIAL BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3502
Country	:	US
Telephone Number	:	954-406-9616
Fax Number	:	561-450-1458

Provider Business Practice Location Address
First Line	:	2975B W COMMERCIAL BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3502
Country	:	US
Telephone Number	:	954-406-9616
Fax Number	:	561-450-1458

Authorized Official
Title or Position	:	DIRECTOR OF COMPLIANCE
Name	:	MRS. BRIDGET G DELLARIA
Credential	:
Telephone Number	:	954-274-4149

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	09/06/2013

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