MEDICARE: ANGELIC HOME CARE AGENCY 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	251S00000X	Community/Behavioral Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1982451571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	1525 ENDERLY RD STE 15
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3341
Country	:	US
Telephone Number	:	980-987-7131
Fax Number	:	980-987-4404

Provider Business Practice Location Address
First Line	:	1525 ENDERLY RD STE 15
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3341
Country	:	US
Telephone Number	:	980-987-7131
Fax Number	:	980-987-4404

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TAMMY HOWARD
Credential	:
Telephone Number	:	980-987-7131

Provider Enumeration Date	:	05/02/2024
Last Update Date	:	10/13/2025

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