MEDICARE: ELIZABETH Q CAULEY

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	13200602117001	GU

General Provider Information

NPI Number	:	1578756490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH Q CAULEY

Provider Business Mailing Address
First Line	:	PO BOX 8365
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96931-8365
Country	:	US
Telephone Number	:	671-649-4000
Fax Number	:	671-646-0150

Provider Business Practice Location Address
First Line	:	285 FARENHOLT AVE
Second Line	:	SUITE C-311
City	:	TAMUNING
State	:	GU
Zip	:	96913-3223
Country	:	US
Telephone Number	:	671-649-4000
Fax Number	:	671-646-0150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	04/08/2013

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