Healthcare Provider Details

I. General information

NPI: 1285228536
Provider Name (Legal Business Name): ANGELS AT HEART HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 N CENTRAL AVE
PHOENIX AZ
85004-1021
US

IV. Provider business mailing address

12605 W NORTH AVE STE 118
BROOKFIELD WI
53005-4629
US

V. Phone/Fax

Practice location:
  • Phone: 414-364-0730
  • Fax:
Mailing address:
  • Phone: 414-364-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KYLE CRAWFORD
Title or Position: OWNER
Credential:
Phone: 414-243-9699