MEDICARE: AMERICAN CARE CONNECTION

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	:	1184878761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN CARE CONNECTION

Provider Business Mailing Address
First Line	:	67430 VISTA CHINO
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-7426
Country	:	US
Telephone Number	:	760-368-7854
Fax Number	:

Provider Business Practice Location Address
First Line	:	67430 VISTA CHINO
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-7426
Country	:	US
Telephone Number	:	760-368-7854
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	WILLIAM GOSS
Credential	:
Telephone Number	:	760-368-7854

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	11/10/2008

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