MEDICARE: AWESOME KARE, 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1710154463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWESOME KARE, INC.

Provider Business Mailing Address
First Line	:	7207 DESIARD ST
Second Line	:	SUITES A & B
City	:	MONROE
State	:	LA
Zip	:	71203-3914
Country	:	US
Telephone Number	:	318-390-4003
Fax Number	:	318-390-1702

Provider Business Practice Location Address
First Line	:	7207 DESIARD ST
Second Line	:	SUITES A & B
City	:	MONROE
State	:	LA
Zip	:	71203-3914
Country	:	US
Telephone Number	:	318-390-4003
Fax Number	:	318-390-1702

Authorized Official
Title or Position	:	OWNER
Name	:	LATROYA KANAYE STATEN
Credential	:
Telephone Number	:	318-390-4003

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	01/28/2009

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Directions to “AWESOME KARE, INC. ” Practice Location

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