MEDICARE: VICKA HEALTH CARE SERVICES INC.

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	:	1598904435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICKA HEALTH CARE SERVICES INC.

Provider Business Mailing Address
First Line	:	1063 GOLDEN LAKES BLVD. SUITE 326
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411
Country	:	US
Telephone Number	:	561-818-1805
Fax Number	:	561-296-6259

Provider Business Practice Location Address
First Line	:	1063 GOLDEN LAKES BLVD
Second Line	:	SUITE 326
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-3357
Country	:	US
Telephone Number	:	561-818-1805
Fax Number	:	561-296-6259

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JERMAINE VICKERS
Credential	:
Telephone Number	:	561-818-1805

Provider Enumeration Date	:	02/17/2009
Last Update Date	:	02/17/2009

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