MEDICARE: SHS SWFL 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	253Z00000X	In Home Supportive Care Agency	232083	FL

General Provider Information

NPI Number	:	1245670132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHS SWFL LLC

Provider Business Mailing Address
First Line	:	12995 S CLEVELAND AVE
Second Line	:	SUITE 40
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3890
Country	:	US
Telephone Number	:	239-243-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	12995 S CLEVELAND AVE
Second Line	:	SUITE 40
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3890
Country	:	US
Telephone Number	:	239-243-8555
Fax Number	:

Authorized Official
Title or Position	:	COO, CFO, OWNER
Name	:	MR. EVAN ZELDEN
Credential	:
Telephone Number	:	239-243-8555

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	06/25/2013

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