MEDICARE: SHARE LIFE LTD. CO.

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1689981664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARE LIFE LTD. CO.

Provider Business Mailing Address
First Line	:	1096 PLAZA DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34743-4069
Country	:	US
Telephone Number	:	407-758-2371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1096 PLAZA DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34743-4069
Country	:	US
Telephone Number	:	407-758-2371
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	EASTER ASIS HANCOCK
Credential	:
Telephone Number	:	407-758-2371

Provider Enumeration Date	:	09/11/2010
Last Update Date	:	09/11/2010

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