MEDICARE: MONTERO HOME CARE SERVICES, LLC

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	MONTERO	VA

General Provider Information

NPI Number	:	1679722490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTERO HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	5441 VA BEACH BLVD
Second Line	:	SUITE #107
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1749
Country	:	US
Telephone Number	:	757-490-0124
Fax Number	:	757-490-0125

Provider Business Practice Location Address
First Line	:	5441 VA BEACH BLVD
Second Line	:	SUITE #107
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1749
Country	:	US
Telephone Number	:	757-490-0124
Fax Number	:	757-490-0125

Authorized Official
Title or Position	:	CFO
Name	:	MR. DENNIS PAUL ACKERMAN
Credential	:
Telephone Number	:	757-621-1630

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/17/2008

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