MEDICARE: ISLAND HOME CARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1184922668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND HOME CARE AGENCY, INC

Provider Business Mailing Address
First Line	:	1200 4TH ST
Second Line	:	SUITE 179
City	:	KEY WEST
State	:	FL
Zip	:	33040-3763
Country	:	US
Telephone Number	:	305-735-4460
Fax Number	:	305-453-6186

Provider Business Practice Location Address
First Line	:	817 SIMONTON ST
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-7445
Country	:	US
Telephone Number	:	305-735-4460
Fax Number	:	305-453-6186

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. KIMBERLY ROBERTS WILKERSON
Credential	:
Telephone Number	:	305-735-4460

Provider Enumeration Date	:	03/07/2011
Last Update Date	:	08/13/2013

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