MEDICARE: BB'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	:	1245053131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BB'S HOME CARE LLC

Provider Business Mailing Address
First Line	:	4503 MONROE ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-4763
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4503 MONROE ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-4763
Country	:	US
Telephone Number	:	414-377-2964
Fax Number	:

Authorized Official
Title or Position	:	OWNER, VICE PRESIDENT
Name	:	DOH BEE
Credential	:
Telephone Number	:	414-377-2964

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	11/07/2024

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