MEDICARE: CAERKILLIAN 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	IHCP-0051	SC

General Provider Information

NPI Number	:	1265889604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAERKILLIAN LLC

Provider Business Mailing Address
First Line	:	1000 MAIN ST
Second Line	:	SUITE 200E
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926-1693
Country	:	US
Telephone Number	:	843-785-6400
Fax Number	:	843-785-6405

Provider Business Practice Location Address
First Line	:	1000 MAIN ST
Second Line	:	SUITE 200E
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926-1693
Country	:	US
Telephone Number	:	843-785-6400
Fax Number	:	843-785-6405

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL FALVO
Credential	:
Telephone Number	:	843-785-6400

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/16/2016

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