MEDICARE: AMADA SENIOR CARE OF KATY, 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	:	1568978419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMADA SENIOR CARE OF KATY, LLC

Provider Business Mailing Address
First Line	:	12808 W AIRPORT BLVD STE 325B
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-6227
Country	:	US
Telephone Number	:	832-403-3217
Fax Number	:	281-888-8281

Provider Business Practice Location Address
First Line	:	12808 W AIRPORT BLVD STE 325B
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-6227
Country	:	US
Telephone Number	:	832-403-3217
Fax Number	:	281-888-8281

Authorized Official
Title or Position	:	PARTNER
Name	:	DAVID DENOBLE
Credential	:
Telephone Number	:	832-403-3217

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	12/14/2017

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