MEDICARE: IMPERIAL 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	:	1356281976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL HOME CARE LLC

Provider Business Mailing Address
First Line	:	20662 N SCOLA ST
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-7320
Country	:	US
Telephone Number	:	602-727-9750
Fax Number	:

Provider Business Practice Location Address
First Line	:	20662 N SCOLA ST
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-7320
Country	:	US
Telephone Number	:	602-727-9750
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BONAVENTURE NGWA
Credential	:
Telephone Number	:	602-727-9750

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	03/31/2026

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