MEDICARE: GAIL'S ANGELS HOME CARE SERVICES, 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	:	1306401112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAIL'S ANGELS HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	12416 SUMMERHOUSE DR APT 12
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-2921
Country	:	US
Telephone Number	:	314-780-6863
Fax Number	:

Provider Business Practice Location Address
First Line	:	12416 SUMMERHOUSE DR APT 12
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-2921
Country	:	US
Telephone Number	:	314-780-6863
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. CARLOS TURNER
Credential	:
Telephone Number	:	314-780-6863

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	05/07/2019

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