MEDICARE: ALOMEGA HOME HEALTH CARE-SA,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		TX

General Provider Information

NPI Number	:	1083149967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALOMEGA HOME HEALTH CARE-SA,LLC

Provider Business Mailing Address
First Line	:	PO BOX 11304
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77842-1304
Country	:	US
Telephone Number	:	979-704-6252
Fax Number	:	979-704-6254

Provider Business Practice Location Address
First Line	:	4064 STATE HIGHWAY 6 S
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8962
Country	:	US
Telephone Number	:	979-704-6252
Fax Number	:	979-704-6254

Authorized Official
Title or Position	:	CEO / ADMINISTRATOR
Name	:	MRS. ALVERNA C. MCCULLOUGH
Credential	:
Telephone Number	:	979-704-6252

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/27/2017

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