MEDICARE: SIMON COMPANION AND HOMEMAKING

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	020088900	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730699893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMON COMPANION AND HOMEMAKING

Provider Business Mailing Address
First Line	:	12458 CONDOR DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-3711
Country	:	US
Telephone Number	:	904-508-2687
Fax Number	:	904-374-5457

Provider Business Practice Location Address
First Line	:	12458 CONDOR DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-3711
Country	:	US
Telephone Number	:	904-508-2687
Fax Number	:	904-374-5457

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	LATRALL SIMON
Credential	:
Telephone Number	:	904-508-2687

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	10/03/2017

Similar Medicare Providers

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Practice Location Address:

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1528525466 — IN LOVING HANDS COMPASSIONATE FAMILY HOME CARE
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Directions to “SIMON COMPANION AND HOMEMAKING ” Practice Location

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