MEDICARE: ANGELIC HOMES

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	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1629813282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC HOMES

Provider Business Mailing Address
First Line	:	25014 TROMBLEY ST
Second Line	:
City	:	HARRISON TOWNSHIP
State	:	MI
Zip	:	48045-6415
Country	:	US
Telephone Number	:	586-252-0288
Fax Number	:

Provider Business Practice Location Address
First Line	:	25014 TROMBLEY ST
Second Line	:
City	:	HARRISON TOWNSHIP
State	:	MI
Zip	:	48045-6415
Country	:	US
Telephone Number	:	586-252-0288
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	WENDY BRIGGS
Credential	:
Telephone Number	:	586-252-0288

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	06/26/2024

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Directions to “ANGELIC HOMES ” Practice Location

Language	Start Address	Practice Location

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