MEDICARE: THERESAS HOUSE 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	:	1235356387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERESAS HOUSE INC

Provider Business Mailing Address
First Line	:	495 BIRCHWOOD LN
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32738-8921
Country	:	US
Telephone Number	:	386-574-7392
Fax Number	:

Provider Business Practice Location Address
First Line	:	495 BIRCHWOOD LN
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32738-8921
Country	:	US
Telephone Number	:	386-574-7392
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MS. THERESA MICHELLE JAKES
Credential	:	OTRL
Telephone Number	:	386-574-7392

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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Directions to “THERESAS HOUSE INC ” Practice Location

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