MEDICARE: JUDITH HOME CARE 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
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1356063218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDITH HOME CARE LLC

Provider Business Mailing Address
First Line	:	2402 SHEEPHORN SUMMIT TRL
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-2083
Country	:	US
Telephone Number	:	240-440-0567
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 SHEEPHORN SUMMIT TRL
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-2083
Country	:	US
Telephone Number	:	240-440-0567
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JUDITH NGITIR
Credential	:
Telephone Number	:	240-440-0567

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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