MEDICARE: SALAM HOME CARE AGENCY 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1528836731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALAM HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	7631 GATHINGS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-2756
Country	:	US
Telephone Number	:	260-206-7929
Fax Number	:

Provider Business Practice Location Address
First Line	:	4202 WARSAW ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-1842
Country	:	US
Telephone Number	:	260-206-7929
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KHIN HTWAY THAW
Credential	:	MA
Telephone Number	:	260-206-7929

Provider Enumeration Date	:	12/18/2023
Last Update Date	:	12/18/2023

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