MEDICARE: REVE ESPERER AMOUR 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

General Provider Information

NPI Number	:	1821415191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVE ESPERER AMOUR LLC

Provider Business Mailing Address
First Line	:	4605 CHARLOTTE HWY
Second Line	:	SUITE 15
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8094
Country	:	US
Telephone Number	:	803-412-4155
Fax Number	:	704-234-6850

Provider Business Practice Location Address
First Line	:	4605 CHARLOTTE HWY
Second Line	:	SUITE 15
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8094
Country	:	US
Telephone Number	:	803-412-4155
Fax Number	:	704-234-6850

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	KATIE TAYLOR
Credential	:
Telephone Number	:	803-412-4155

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	03/25/2014

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Directions to “REVE ESPERER AMOUR LLC ” Practice Location

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