MEDICARE: MEDLIFE HOME HEALTH 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1891017273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDLIFE HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	6243 IH 10 W STE 875
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2048
Country	:	US
Telephone Number	:	210-624-3702
Fax Number	:	210-624-3700

Provider Business Practice Location Address
First Line	:	6243 IH 10 W STE 875
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2048
Country	:	US
Telephone Number	:	210-624-3702
Fax Number	:	210-624-3700

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SEDAT NECIPOGLU
Credential	:
Telephone Number	:	210-624-3702

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	02/25/2010

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