MEDICARE: ABI CARE HOME HEALTH, 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	251E00000X	Home Health Agency	004704	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0000HH9268	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1164428702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABI CARE HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	2974 LBJ FWY
Second Line	:	SUITE 401
City	:	DALLAS
State	:	TX
Zip	:	75234-7602
Country	:	US
Telephone Number	:	972-241-2419
Fax Number	:

Provider Business Practice Location Address
First Line	:	2974 LBJ FWY
Second Line	:	SUITE 401
City	:	DALLAS
State	:	TX
Zip	:	75234-7602
Country	:	US
Telephone Number	:	972-241-2419
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	OLATUNBOSUN OLUSEGUN OSUKOYA
Credential	:
Telephone Number	:	972-241-2419

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	04/03/2013

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