Healthcare Provider Details

I. General information

NPI: 1205749306
Provider Name (Legal Business Name): CHARLIES ANGELS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE N
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST STE N
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 718-598-3077
  • Fax: 855-589-3052
Mailing address:
  • Phone: 718-598-3077
  • Fax: 855-589-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name: EBONY BUSSEY
Title or Position: CEO/FOUNDER
Credential:
Phone: 718-598-3077