MEDICARE: ANGELS IN THE MIDST HOME CARE 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	:	1649927377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS IN THE MIDST HOME CARE LLC

Provider Business Mailing Address
First Line	:	8180 PENSACOLA BLVD STE 215
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-4354
Country	:	US
Telephone Number	:	866-563-9853
Fax Number	:	850-285-0209

Provider Business Practice Location Address
First Line	:	8180 PENSACOLA BLVD STE 215
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-4354
Country	:	US
Telephone Number	:	866-563-9853
Fax Number	:	850-285-0209

Authorized Official
Title or Position	:	OWNER
Name	:	GABRIELLE CRENSHAW
Credential	:
Telephone Number	:	850-239-6488

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	03/02/2022

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