MEDICARE: AMMD VENTURES 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	:	1194972315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMMD VENTURES INC

Provider Business Mailing Address
First Line	:	464 SEBASTIAN SQ
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32095-6863
Country	:	US
Telephone Number	:	904-826-3666
Fax Number	:

Provider Business Practice Location Address
First Line	:	4651 SALISBURY RD
Second Line	:	SUITE 452
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6107
Country	:	US
Telephone Number	:	904-838-6148
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROSE RUSCITTO
Credential	:
Telephone Number	:	904-838-6148

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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