MEDICARE: ANGELICARE IN HOME COMPANION CARE INC.

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	:	1902318454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELICARE IN HOME COMPANION CARE INC.

Provider Business Mailing Address
First Line	:	4840 N 1ST ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-0525
Country	:	US
Telephone Number	:	559-453-0151
Fax Number	:	559-682-1071

Provider Business Practice Location Address
First Line	:	4840 N 1ST ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-0525
Country	:	US
Telephone Number	:	559-453-0151
Fax Number	:	559-682-1071

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. STEVEN GARCIA
Credential	:
Telephone Number	:	559-453-0151

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	10/24/2017

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