Healthcare Provider Details

I. General information

NPI: 1295667046
Provider Name (Legal Business Name): MAMA'S CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 E 51ST AVE
GARY IN
46409-2920
US

IV. Provider business mailing address

1238 E 51ST AVE
GARY IN
46409-2920
US

V. Phone/Fax

Practice location:
  • Phone: 219-200-7862
  • Fax:
Mailing address:
  • Phone: 219-200-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NTALLY KANOUTE
Title or Position: CEO
Credential:
Phone: 219-200-7862