MEDICARE: ANGELS HEALING HOME HEALTH CARE CORP

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	251E00000X	Home Health Agency		CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	058175	OTHER	CA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	HHA08175F	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1689672503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS HEALING HOME HEALTH CARE CORP

Provider Business Mailing Address
First Line	:	13663 PRAIRIE AVE
Second Line	:	SUITE D
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-7372
Country	:	US
Telephone Number	:	310-675-6767
Fax Number	:	310-675-6737

Provider Business Practice Location Address
First Line	:	13663 PRAIRIE AVE
Second Line	:	SUITE D
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-7372
Country	:	US
Telephone Number	:	310-675-6767
Fax Number	:	310-675-6737

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. THERESA NGOZI ADUBA
Credential	:	RN
Telephone Number	:	310-675-6767

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	02/26/2008

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Directions to “ANGELS HEALING HOME HEALTH CARE CORP ” Practice Location

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