MEDICARE: AWESOME 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	:	1285332189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWESOME HOME CARE LLC

Provider Business Mailing Address
First Line	:	8421 N MATTOX RD APT R95
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-2611
Country	:	US
Telephone Number	:	816-277-4174
Fax Number	:

Provider Business Practice Location Address
First Line	:	4655 LONDONDERRY CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221-2934
Country	:	US
Telephone Number	:	816-277-4174
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MOHAMED ABDI
Credential	:
Telephone Number	:	816-277-4174

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	02/20/2023

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