MEDICARE: JOHNNY ANGEL'S CARE HOME 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1447086863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNNY ANGEL'S CARE HOME INC.

Provider Business Mailing Address
First Line	:	4460 MARLENA CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4460 MARLENA CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2004
Country	:	US
Telephone Number	:	702-434-5882
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	ARLENE ROCHALSKI
Credential	:
Telephone Number	:	323-229-6098

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	09/11/2024

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