MEDICARE: AVENCARE PROVIDER 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1104789775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENCARE PROVIDER SERVICES LLC

Provider Business Mailing Address
First Line	:	19002 DERRINGTON MANOR LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3586
Country	:	US
Telephone Number	:	832-219-5032
Fax Number	:	713-575-3003

Provider Business Practice Location Address
First Line	:	19002 DERRINGTON MANOR LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-3586
Country	:	US
Telephone Number	:	832-219-5032
Fax Number	:	713-575-3003

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	KARIMAT OMOWUNMI ABDULWAHAB
Credential	:
Telephone Number	:	832-219-5032

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “AVENCARE PROVIDER SERVICES LLC ” Practice Location

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