MEDICARE: AGMUOS 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		IL

General Provider Information

NPI Number	:	1962821710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGMUOS LLC

Provider Business Mailing Address
First Line	:	704 E 44TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-3541
Country	:	US
Telephone Number	:	773-451-0600
Fax Number	:	773-451-0607

Provider Business Practice Location Address
First Line	:	4850 N SAWYER AVE
Second Line	:	SUITE# 202
City	:	CHICAGO
State	:	IL
Zip	:	60625-5211
Country	:	US
Telephone Number	:	773-451-0600
Fax Number	:	773-451-0607

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	AYODELE AGUNBIADE
Credential	:
Telephone Number	:	773-451-0600

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	04/09/2014

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