MEDICARE: I&I ONGWELA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	172A00000X	Driver
2	174200000X	Meals Provider
3	347C00000X	Private Vehicle
4	372500000X	Chore Provider
5	372600000X	Adult Companion
6	376K00000X	Nurse's Aide
7	251E00000X	Home Health Agency
8	251J00000X	Nursing Care Agency
9	253Z00000X	In Home Supportive Care Agency
10	343900000X	Non-emergency Medical Transport (VAN)
11	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1811705510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I&I ONGWELA LLC

Provider Business Mailing Address
First Line	:	1741 GREENBRIAR DR
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-5771
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 GREENBRIAR DR
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-5771
Country	:	US
Telephone Number	:	269-998-7615
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. JACK ONGWELA
Credential	:
Telephone Number	:	269-998-7615

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	12/27/2024

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Directions to “I&I ONGWELA LLC ” Practice Location

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