MEDICARE: ANGEL SENT HOMECARE 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	376J00000X	Homemaker
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	COMPANION	OTHER	FL	COMPANION

General Provider Information

NPI Number	:	1760110407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL SENT HOMECARE LLC

Provider Business Mailing Address
First Line	:	5503 EARTHA DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-2141
Country	:	US
Telephone Number	:	904-930-7735
Fax Number	:

Provider Business Practice Location Address
First Line	:	5503 EARTHA DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-2141
Country	:	US
Telephone Number	:	904-930-7735
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEMETRIA BRYANT
Credential	:
Telephone Number	:	904-930-7735

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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