MEDICARE: MYCHOICE 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1710447644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYCHOICE HOME CARE LLC

Provider Business Mailing Address
First Line	:	5120 LEERAY RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9233
Country	:	US
Telephone Number	:	817-547-0635
Fax Number	:

Provider Business Practice Location Address
First Line	:	5120 LEERAY RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9233
Country	:	US
Telephone Number	:	817-547-0635
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANNA MARIA MUGISHA
Credential	:	RN
Telephone Number	:	817-547-0635

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	03/25/2019

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