MEDICARE: TRI-COUNTY LIFE CARE, 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	232342	FL

General Provider Information

NPI Number	:	1639444219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-COUNTY LIFE CARE, INC

Provider Business Mailing Address
First Line	:	7050 W PALMETTO PARK RD
Second Line	:	154
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3426
Country	:	US
Telephone Number	:	954-893-9499
Fax Number	:	954-893-9455

Provider Business Practice Location Address
First Line	:	7050 W PALMETTO PARK RD
Second Line	:	154
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3426
Country	:	US
Telephone Number	:	954-893-9499
Fax Number	:	954-893-9455

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PAULINE JONES
Credential	:
Telephone Number	:	954-893-9499

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	03/15/2012

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