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NPI Code Detail

MEDICARE: ABODE CARE PARTNERS LTC VB, LLC

MEDICARE: ABODE CARE PARTNERS LTC VB, 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
1363L00000XNurse Practitioner

General Provider Information

NPI Number : 1215706494
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABODE CARE PARTNERS LTC VB, LLC
Provider Business Mailing Address
First Line : 805 N WHITTINGTON PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-7101
Country : US
Telephone Number : 502-394-2100
Fax Number :
Provider Business Practice Location Address
First Line : 2545 24TH ST
Second Line :
City : ROCK ISLAND
State : IL
Zip : 61201-5305
Country : US
Telephone Number : 800-807-6555
Fax Number : 855-316-2999
Authorized Official
Title or Position : MGR PROVIDER ENROLLMENT
Name : ANGIE MATTINGLY
Credential :
Telephone Number : 502-394-2100
Provider Enumeration Date : 12/28/2023
Last Update Date : 06/01/2026

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Directions to “ABODE CARE PARTNERS LTC VB, LLC ” Practice Location

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