MEDICARE: QUALIFIED HOMECARE SERVICES INC

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	30210999	FL

General Provider Information

NPI Number	:	1972765485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALIFIED HOMECARE SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 640950
Second Line	:
City	:	NO MIAMI BCH
State	:	FL
Zip	:	33164
Country	:	US
Telephone Number	:	305-652-1266
Fax Number	:	305-652-7033

Provider Business Practice Location Address
First Line	:	319 NE 167 ST
Second Line	:
City	:	NO MIAMI BCH
State	:	FL
Zip	:	33162
Country	:	US
Telephone Number	:	305-652-1266
Fax Number	:	305-652-7033

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	AUDREYA MCLEAN
Credential	:
Telephone Number	:	305-652-1266

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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