MEDICARE: ALTRU 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	374700000X	Technician

General Provider Information

NPI Number	:	1033752720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTRU HOME CARE LLC

Provider Business Mailing Address
First Line	:	13309 FALL MANOR DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2431
Country	:	US
Telephone Number	:	972-246-7918
Fax Number	:

Provider Business Practice Location Address
First Line	:	13309 FALL MANOR DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2431
Country	:	US
Telephone Number	:	972-246-7918
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. WUBU KEBEH SAMOLU
Credential	:
Telephone Number	:	972-246-7918

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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