MEDICARE: HARVEST HOME HEALTHCARE, 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

General Provider Information

NPI Number	:	1174934988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVEST HOME HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	3980 TAMPA RD
Second Line	:	STE. 101 B,C
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 TAMPA RD
Second Line	:	STE. 101 B,C
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3223
Country	:	US
Telephone Number	:	813-317-1060
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ROLANDO RIOS
Credential	:
Telephone Number	:	813-317-1060

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	05/14/2014

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