MEDICARE: FAMILY CARE NURSES REG 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	376K00000X	Nurse's Aide	30211111	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558663161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE NURSES REG LLC

Provider Business Mailing Address
First Line	:	4047 OKEECHOBEE BLVD
Second Line	:	#124
City	:	WEST PALM BCH
State	:	FL
Zip	:	33409
Country	:	US
Telephone Number	:	561-686-4552
Fax Number	:	561-686-4528

Provider Business Practice Location Address
First Line	:	4047 OKEECHOBEE BLVD
Second Line	:	#124
City	:	WEST PALM BCH
State	:	FL
Zip	:	33409
Country	:	US
Telephone Number	:	561-686-4552
Fax Number	:	561-686-4528

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CARMEN IULDA JOHNSON
Credential	:
Telephone Number	:	561-686-4552

Provider Enumeration Date	:	12/02/2010
Last Update Date	:	12/02/2010

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