MEDICARE: ANGEL CARE HOME HEALTH 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1891475323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL CARE HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	12019 DUKE LANCASTER DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-4032
Country	:	US
Telephone Number	:	803-616-9308
Fax Number	:

Provider Business Practice Location Address
First Line	:	12019 DUKE LANCASTER DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-4032
Country	:	US
Telephone Number	:	803-616-9308
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTOPHER G EDWARDS SR.
Credential	:
Telephone Number	:	803-616-9308

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	07/19/2023

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