MEDICARE: ABODE HEALTHCARE AGENCY, 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1235628272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABODE HEALTHCARE AGENCY, LLC

Provider Business Mailing Address
First Line	:	363 N SAM HOUSTON PKWY E STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-2413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 N SAM HOUSTON PKWY E STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-2413
Country	:	US
Telephone Number	:	832-802-9711
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. REBECCA CARTER
Credential	:
Telephone Number	:	281-789-2616

Provider Enumeration Date	:	05/04/2018
Last Update Date	:	01/13/2021

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