MEDICARE: BE HEALED HOMECARE, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1366017980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BE HEALED HOMECARE, LLC

Provider Business Mailing Address
First Line	:	175 CANTON ST APT B2
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-2228
Country	:	US
Telephone Number	:	203-887-0095
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 CANTON ST APT B2
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-2228
Country	:	US
Telephone Number	:	203-887-0095
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EBELE IREMEKA
Credential	:
Telephone Number	:	203-887-0095

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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