MEDICARE: LAWRENCE HOME 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	310400000X	Assisted Living Facility	AL 8432	FL

General Provider Information

NPI Number	:	1710140256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE HOME CARE

Provider Business Mailing Address
First Line	:	2650 NW 15TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-7652
Country	:	US
Telephone Number	:	305-225-7119
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 NW 15TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-7652
Country	:	US
Telephone Number	:	305-225-7119
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ILEANA MARIN
Credential	:
Telephone Number	:	305-225-7119

Provider Enumeration Date	:	07/04/2008
Last Update Date	:	07/04/2008

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Directions to “LAWRENCE HOME CARE ” Practice Location

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