MEDICARE: TERRICENA AJRAMIREZ

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	:	1619109857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRICENA AJRAMIREZ

Provider Business Mailing Address
First Line	:	HIGHWAY 264 LOS VERDES TRAILER COURT
Second Line	:
City	:	SAINT MICHAELS
State	:	AZ
Zip	:	86511-4613
Country	:	US
Telephone Number	:	928-810-4177
Fax Number	:	928-810-4178

Provider Business Practice Location Address
First Line	:	HIGHWAY 264 LOS VERDES TRAILER COURT
Second Line	:
City	:	SAINT MICHAELS
State	:	AZ
Zip	:	86511-4613
Country	:	US
Telephone Number	:	928-810-4177
Fax Number	:	928-810-4178

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TERRICENA AJRAMIREZ
Credential	:
Telephone Number	:	928-810-4177

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	08/21/2009

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