MEDICARE: 211 GROUP 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	253Z00000X	In Home Supportive Care Agency
2	251J00000X	Nursing Care Agency		MI

General Provider Information

NPI Number	:	1619149986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	211 GROUP INC

Provider Business Mailing Address
First Line	:	21901 HARPER AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2217
Country	:	US
Telephone Number	:	586-473-6188
Fax Number	:	586-473-6199

Provider Business Practice Location Address
First Line	:	21901 HARPER AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-2217
Country	:	US
Telephone Number	:	586-473-6188
Fax Number	:	586-473-6199

Authorized Official
Title or Position	:	CFO
Name	:	MR. SWADIE OKON
Credential	:
Telephone Number	:	586-473-6188

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	04/02/2009

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