MEDICARE: ALLY 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	:	1649596669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLY HOME CARE, LLC

Provider Business Mailing Address
First Line	:	1000 HERITAGE CENTER CIR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-4463
Country	:	US
Telephone Number	:	956-466-3284
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 HERITAGE CENTER CIR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-4463
Country	:	US
Telephone Number	:	956-466-3284
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JOANNE MADRID
Credential	:
Telephone Number	:	956-466-3284

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/15/2010

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