MEDICARE: IMMEDIATE HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1275024622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMEDIATE HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	3730 S 148TH ST APT 56
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98168-4364
Country	:	US
Telephone Number	:	206-643-7815
Fax Number	:

Provider Business Practice Location Address
First Line	:	6727 MLK JR WAY S STE C
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3205
Country	:	US
Telephone Number	:	206-643-7815
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AHMED YUSSUF
Credential	:
Telephone Number	:	612-814-7838

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	05/22/2018

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