MEDICARE: CDS CARE & SUPPORT

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	299994703	FL

General Provider Information

NPI Number	:	1477042620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDS CARE & SUPPORT

Provider Business Mailing Address
First Line	:	2726 OAK RIDGE CT STE 502
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9356
Country	:	US
Telephone Number	:	239-931-0158
Fax Number	:	850-757-0070

Provider Business Practice Location Address
First Line	:	2726 OAK RIDGE CT STE 502
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9356
Country	:	US
Telephone Number	:	239-931-0158
Fax Number	:	850-757-0070

Authorized Official
Title or Position	:	CEO
Name	:	MR. MANUEL CHAVEZ
Credential	:
Telephone Number	:	239-931-0262

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	11/29/2018

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