MEDICARE: FLORIDA SENIOR CARE SERVICES, 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	SW6243	FL
2	251B00000X	Case Management Agency	SW6243	FL
3	251S00000X	Community/Behavioral Health Agency	SW6243	FL

General Provider Information

NPI Number	:	1982880688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA SENIOR CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 691114
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32969-1114
Country	:	US
Telephone Number	:	772-559-8673
Fax Number	:	772-564-8719

Provider Business Practice Location Address
First Line	:	5910 CARRIAGE LAKE CT
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-9476
Country	:	US
Telephone Number	:	772-559-8673
Fax Number	:	772-564-8719

Authorized Official
Title or Position	:	VP BUSINESS DEVELOPMENT
Name	:	MR. JERRY LLOYD TACKETT
Credential	:	M.ED., BA, BS, AAMS.
Telephone Number	:	772-559-8673

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	01/14/2008

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