MEDICARE: AFFECTIONATE CARE SERVICE 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	253Z00000X	In Home Supportive Care Agency	693015898	FL
2	251E00000X	Home Health Agency	693015896	FL

General Provider Information

NPI Number	:	1518273895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFECTIONATE CARE SERVICE LLC

Provider Business Mailing Address
First Line	:	7846 STEPHENSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2748
Country	:	US
Telephone Number	:	904-365-9543
Fax Number	:

Provider Business Practice Location Address
First Line	:	7846 STEPHENSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2748
Country	:	US
Telephone Number	:	904-365-9543
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. ARTHER LEE WILLIAMSON
Credential	:
Telephone Number	:	904-365-9543

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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