MEDICARE: LILY'S SECURE HOME CARE , 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	:	1376974410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILY'S SECURE HOME CARE , INC

Provider Business Mailing Address
First Line	:	3011 W 76TH ST APT 205
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-3809
Country	:	US
Telephone Number	:	305-684-4797
Fax Number	:	786-483-7640

Provider Business Practice Location Address
First Line	:	3011 W 76TH ST APT 205
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-3809
Country	:	US
Telephone Number	:	305-684-4797
Fax Number	:	786-483-7640

Authorized Official
Title or Position	:	CNA
Name	:	LIDICE DOMINGUEZ
Credential	:
Telephone Number	:	305-684-4797

Provider Enumeration Date	:	11/27/2013
Last Update Date	:	11/27/2013

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