MEDICARE: WHITSYMS HOME HEALTH OF THE GULF COAST, 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

General Provider Information

NPI Number	:	1548520810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITSYMS HOME HEALTH OF THE GULF COAST, LLC

Provider Business Mailing Address
First Line	:	3800 COLONIAL BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1075
Country	:	US
Telephone Number	:	239-936-3480
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 COLONIAL BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1075
Country	:	US
Telephone Number	:	239-936-3480
Fax Number	:

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	TRICIA CHRISTMAS
Credential	:
Telephone Number	:	941-623-2593

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	05/21/2012

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