MEDICARE: MARSHALL'S HOME HEALTH AIDE

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	233172	FL

General Provider Information

NPI Number	:	1447665096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL'S HOME HEALTH AIDE

Provider Business Mailing Address
First Line	:	4600 TOUCHTON RD E
Second Line	:	BUILDING 100 SUITE 150
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-8299
Country	:	US
Telephone Number	:	904-438-2379
Fax Number	:	904-738-7246

Provider Business Practice Location Address
First Line	:	4600 TOUCHTON RD E
Second Line	:	BUILDING 100 SUITE 150
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-8299
Country	:	US
Telephone Number	:	904-438-2379
Fax Number	:	904-738-7246

Authorized Official
Title or Position	:	OWNER
Name	:	MISS ROSALIND RENEE MARSHALL
Credential	:
Telephone Number	:	904-438-2379

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	06/23/2014

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