MEDICARE: AMIABLE HOME CARE AGENCY 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	:	1871339606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIABLE HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	4532 S LAKE PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4532 S LAKE PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4510
Country	:	US
Telephone Number	:	312-292-6913
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/OWNER
Name	:	JUDE ORAEGBU
Credential	:
Telephone Number	:	312-292-6913

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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