MEDICARE: ANGELIC HOME CARE INC.

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	84718	MD

General Provider Information

NPI Number	:	1265662357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC HOME CARE INC.

Provider Business Mailing Address
First Line	:	4670 WILLIAMS WHARF RD
Second Line	:
City	:	SAINT LEONARD
State	:	MD
Zip	:	20685-3044
Country	:	US
Telephone Number	:	301-618-9223
Fax Number	:	443-295-7814

Provider Business Practice Location Address
First Line	:	4670 WILLIAMS WHARF RD
Second Line	:
City	:	SAINT LEONARD
State	:	MD
Zip	:	20685-3044
Country	:	US
Telephone Number	:	301-618-9223
Fax Number	:	443-295-7814

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT TERRY GRAHAM
Credential	:
Telephone Number	:	301-618-9223

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	07/27/2009

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