MEDICARE: AVEENA HEALTH 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	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1831819788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVEENA HEALTH LLC.

Provider Business Mailing Address
First Line	:	13978 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5359
Country	:	US
Telephone Number	:	832-279-9406
Fax Number	:	281-343-3001

Provider Business Practice Location Address
First Line	:	13978 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5359
Country	:	US
Telephone Number	:	832-279-9406
Fax Number	:	281-343-3001

Authorized Official
Title or Position	:	OWNER
Name	:	OLUYEMI OLADIPO
Credential	:
Telephone Number	:	832-279-9406

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	08/31/2022

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