MEDICARE: MR. ABRAHAM MAT

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	:	1588365191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ABRAHAM MAT

Provider Business Mailing Address
First Line	:	3291 W 115TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-2756
Country	:	US
Telephone Number	:	216-688-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3291 W 115TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-2756
Country	:	US
Telephone Number	:	216-688-8111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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