MEDICARE: COMPLETE HOME CARE

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	3140N1450X	Pediatric Skilled Nursing Facility	304749-1	NY

General Provider Information

NPI Number	:	1912206848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE HOME CARE

Provider Business Mailing Address
First Line	:	715 SAINT MARKS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-3767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 SAINT MARKS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-3767
Country	:	US
Telephone Number	:	718-493-4143
Fax Number	:

Authorized Official
Title or Position	:	LPN
Name	:	KENDRA DIONE POPWELL
Credential	:
Telephone Number	:	347-267-4424

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	03/17/2011

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Directions to “COMPLETE HOME CARE ” Practice Location

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