MEDICARE: NUESTRA CASA II, 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	385H00000X	Respite Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992122881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUESTRA CASA II, INC.

Provider Business Mailing Address
First Line	:	2832 GIULIANO AVE
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3725
Country	:	US
Telephone Number	:	561-252-6399
Fax Number	:

Provider Business Practice Location Address
First Line	:	2832 GIULIANO AVE
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3725
Country	:	US
Telephone Number	:	561-252-6399
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CONRADO BARRIO
Credential	:
Telephone Number	:	561-252-6399

Provider Enumeration Date	:	03/28/2014
Last Update Date	:	03/28/2014

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Directions to “NUESTRA CASA II, INC. ” Practice Location

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