MEDICARE: MTD GALAXY 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

General Provider Information

NPI Number	:	1598200024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MTD GALAXY LLC.

Provider Business Mailing Address
First Line	:	6619 CRISTINA MARIE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-5751
Country	:	US
Telephone Number	:	407-970-2341
Fax Number	:

Provider Business Practice Location Address
First Line	:	6619 CRISTINA MARIE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-5751
Country	:	US
Telephone Number	:	407-970-2341
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDY TRUONG
Credential	:
Telephone Number	:	407-970-2341

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	12/19/2016

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