MEDICARE: MAI VIET CARE INC.

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		TX

General Provider Information

NPI Number	:	1497150064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAI VIET CARE INC.

Provider Business Mailing Address
First Line	:	PO BOX 594
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-0594
Country	:	US
Telephone Number	:	469-360-5209
Fax Number	:	817-953-8892

Provider Business Practice Location Address
First Line	:	2416 LAKEWOOD DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6800
Country	:	US
Telephone Number	:	469-360-5209
Fax Number	:	817-953-8892

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. ANDY VU
Credential	:
Telephone Number	:	469-360-5209

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	03/30/2015

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