MEDICARE: SENIOR HOME CARE, 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	:	1194776138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HOME CARE, INC.

Provider Business Mailing Address
First Line	:	6330 SPRINT PKWY STE 300
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4245 KINGS HWY UNIT B
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-8416
Country	:	US
Telephone Number	:	941-623-4882
Fax Number	:	941-467-3384

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	941-623-4882

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	09/18/2023

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