MEDICARE: REAL HOMECARE AGENT 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	:	1619723566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REAL HOMECARE AGENT LLC

Provider Business Mailing Address
First Line	:	1232 S WACO ST UNIT C
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80017-5771
Country	:	US
Telephone Number	:	720-725-7776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1582 S PARKER RD STE 104
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2715
Country	:	US
Telephone Number	:	720-725-7776
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMOUD HASSAN ALI
Credential	:
Telephone Number	:	720-725-7776

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	04/30/2024

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