MEDICARE: ASTRAL ANGELS HOMECARE

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	:	1497545669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTRAL ANGELS HOMECARE

Provider Business Mailing Address
First Line	:	1617 PARK PLACE AVE # 10
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1380
Country	:	US
Telephone Number	:	817-501-9176
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 PARK PLACE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1380
Country	:	US
Telephone Number	:	469-896-1765
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALIZE WATSON
Credential	:
Telephone Number	:	817-501-9176

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	05/09/2025

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