MEDICARE: WALI 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	:	1457121832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALI HOME CARE LLC

Provider Business Mailing Address
First Line	:	5810 WAYCROSS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-3845
Country	:	US
Telephone Number	:	260-715-0081
Fax Number	:	260-296-2677

Provider Business Practice Location Address
First Line	:	5810 WAYCROSS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-3845
Country	:	US
Telephone Number	:	260-715-0081
Fax Number	:	260-296-2677

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	KALELOT LA
Credential	:
Telephone Number	:	260-715-0081

Provider Enumeration Date	:	01/05/2024
Last Update Date	:	01/05/2024

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