MEDICARE: JUVO HOME CARE, LLC

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	253Z00000X	In Home Supportive Care Agency	2203782754	LA

General Provider Information

NPI Number	:	1740630870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUVO HOME CARE, LLC

Provider Business Mailing Address
First Line	:	11843 BRICKSOME AVE
Second Line	:	SUITE B
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5310
Country	:	US
Telephone Number	:	225-332-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	11843 BRICKSOME AVE
Second Line	:	SUITE B
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5310
Country	:	US
Telephone Number	:	225-332-5600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANA NOLA SANFORD
Credential	:
Telephone Number	:	225-332-5600

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	06/20/2016

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