MEDICARE: GENCARE THERAPY 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	310400000X	Assisted Living Facility	12781	FL

General Provider Information

NPI Number	:	1639537566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENCARE THERAPY INC.

Provider Business Mailing Address
First Line	:	15404 HERON HIDEAWAY CIR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-1708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9436 AZALEA RIDGE WAY
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-5064
Country	:	US
Telephone Number	:	407-734-5026
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CARINA QUIAMBAO
Credential	:
Telephone Number	:	407-970-5029

Provider Enumeration Date	:	02/06/2016
Last Update Date	:	02/06/2016

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