MEDICARE: VICKIE'S 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1104368224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICKIE'S HOME CARE LLC

Provider Business Mailing Address
First Line	:	13785 RESEARCH BLVD
Second Line	:	SUITE 125
City	:	AUSTIN
State	:	TX
Zip	:	78750-1873
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13785 RESEARCH BLVD
Second Line	:	SUITE 125
City	:	AUSTIN
State	:	TX
Zip	:	78750-1873
Country	:	US
Telephone Number	:	512-655-2139
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ISAAC ADUSEI
Credential	:
Telephone Number	:	818-205-8178

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	11/07/2016

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