MEDICARE: WOODVIEW HOME CARE LLC

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	251E00000X	IN

General Provider Information

NPI Number	:	1508123548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODVIEW HOME CARE LLC

Provider Business Mailing Address
First Line	:	3417 EAST STATE BLVD.
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4803
Country	:	US
Telephone Number	:	260-969-2000
Fax Number	:	260-969-0323

Provider Business Practice Location Address
First Line	:	3417 EAST STATE BLVD.
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4803
Country	:	US
Telephone Number	:	260-969-2000
Fax Number	:	260-969-0323

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS/OWNER
Name	:	JUSTIN ALEXANDER AUGUST
Credential	:
Telephone Number	:	260-969-2000

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	04/16/2012

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