MEDICARE: EMERALD HOME HEALTHCARE, 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	299993567	FL

General Provider Information

NPI Number	:	1689907933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD HOME HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	3923 LAKE WORTH RD
Second Line	:	SUITE 112
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4049
Country	:	US
Telephone Number	:	561-304-4478
Fax Number	:	561-304-4479

Provider Business Practice Location Address
First Line	:	3923 LAKE WORTH RD
Second Line	:	SUITE 112
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4049
Country	:	US
Telephone Number	:	561-304-4478
Fax Number	:	561-304-4479

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. AVIS SPRADLEY STEPHENS
Credential	:	RN
Telephone Number	:	561-304-4478

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	09/18/2009

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