MEDICARE: ANTAEUS HEALTH SERVICES OF BROWARD CORP

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING MEDICARE#	OTHER	FL	PENDING MEDICARE#

General Provider Information

NPI Number	:	1841463254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTAEUS HEALTH SERVICES OF BROWARD CORP

Provider Business Mailing Address
First Line	:	3127 W HALLANDALE BEACH BLVD
Second Line	:	UNIT 115 B
City	:	HALLANDALE
State	:	FL
Zip	:	33009-5150
Country	:	US
Telephone Number	:	954-989-1011
Fax Number	:	954-989-9669

Provider Business Practice Location Address
First Line	:	3127 W HALLANDALE BEACH BLVD
Second Line	:	UNIT 115 B
City	:	HALLANDALE
State	:	FL
Zip	:	33009-5150
Country	:	US
Telephone Number	:	954-989-1011
Fax Number	:	954-989-9669

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUYIN RETA
Credential	:
Telephone Number	:	954-989-1011

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

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