MEDICARE: INTERIM HOMESTYLE SERVICES, 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	:	1396765624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERIM HOMESTYLE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1601 SAWGRASS CORPORATE PKWY
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-2883
Country	:	US
Telephone Number	:	954-858-2871
Fax Number	:	954-858-2710

Provider Business Practice Location Address
First Line	:	8939 S SEPULVEDA BLVD
Second Line	:	SUITE 261
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3631
Country	:	US
Telephone Number	:	310-338-1289
Fax Number	:	310-338-9154

Authorized Official
Title or Position	:	CFO
Name	:	MR. MICHAEL SLUPECKI
Credential	:
Telephone Number	:	954-858-2753

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	11/13/2008

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