MEDICARE: ATHENA HOME HEALTH AGENCY, 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	:	1558599613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHENA HOME HEALTH AGENCY, LLC.

Provider Business Mailing Address
First Line	:	3350 SW 148TH AVE
Second Line	:	STE 110
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3257
Country	:	US
Telephone Number	:	954-734-2746
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 SW 148TH AVE
Second Line	:	STE 110
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3257
Country	:	US
Telephone Number	:	954-734-2746
Fax Number	:

Authorized Official
Title or Position	:	OWNER / ADMINISTRATOR
Name	:	MR. JESUS RODRIGUEZ
Credential	:
Telephone Number	:	954-734-2746

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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