MEDICARE: EXTENDED HANDS LIFECARE LLC

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	:	1235431545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED HANDS LIFECARE LLC

Provider Business Mailing Address
First Line	:	800 WESTWOOD SQ
Second Line	:	SUITE E
City	:	OVIEDO
State	:	FL
Zip	:	32765-8849
Country	:	US
Telephone Number	:	407-278-4570
Fax Number	:	321-348-9515

Provider Business Practice Location Address
First Line	:	800 WESTWOOD SQ
Second Line	:	SUITE E
City	:	OVIEDO
State	:	FL
Zip	:	32765-8849
Country	:	US
Telephone Number	:	407-278-4570
Fax Number	:	321-348-9515

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. DAVID R KISER
Credential	:
Telephone Number	:	407-278-4570

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	11/19/2010

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