MEDICARE: CORBETTS ELDERLY CARES U ANYWHERE

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	343900000X	Non-emergency Medical Transport (VAN)	PO9000056589	FL

General Provider Information

NPI Number	:	1295965341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORBETTS ELDERLY CARES U ANYWHERE

Provider Business Mailing Address
First Line	:	P.O. BOX 1036
Second Line	:
City	:	WOODVILLE
State	:	FL
Zip	:	32362
Country	:	US
Telephone Number	:	850-345-3817
Fax Number	:	850-325-1429

Provider Business Practice Location Address
First Line	:	2906 PROSPECT ST.
Second Line	:
City	:	TALLA
State	:	FL
Zip	:	32301
Country	:	US
Telephone Number	:	850-345-3817
Fax Number	:	850-325-1429

Authorized Official
Title or Position	:	TRANSPORTATION
Name	:	MRS. SHERIKA S CORBETT
Credential	:
Telephone Number	:	850-345-3817

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	07/23/2009

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