MEDICARE: REYBOZE 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	:	1154944353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYBOZE LLC

Provider Business Mailing Address
First Line	:	2860 FREEDOM DR # B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3856
Country	:	US
Telephone Number	:	302-559-2726
Fax Number	:

Provider Business Practice Location Address
First Line	:	2860 FREEDOM DR # B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3856
Country	:	US
Telephone Number	:	302-559-2726
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL ILODIGWE
Credential	:	DR.
Telephone Number	:	302-559-2726

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	07/27/2020

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Directions to “REYBOZE LLC ” Practice Location

Language	Start Address	Practice Location

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