MEDICARE: SUZANNE'S PERSONAL CARE

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		FL

General Provider Information

NPI Number	:	1679801211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANNE'S PERSONAL CARE

Provider Business Mailing Address
First Line	:	8507 S FEDERAL HWY
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3346
Country	:	US
Telephone Number	:	772-344-6780
Fax Number	:	772-344-6079

Provider Business Practice Location Address
First Line	:	8507 S FEDERAL HWY
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3346
Country	:	US
Telephone Number	:	772-344-6780
Fax Number	:	772-344-6079

Authorized Official
Title or Position	:	OWNER
Name	:	SUZANNE GOKOOL-POWELL
Credential	:
Telephone Number	:	772-344-6780

Provider Enumeration Date	:	11/19/2009
Last Update Date	:	11/19/2009

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