Healthcare Provider Details

I. General information

NPI: 1942810809
Provider Name (Legal Business Name): PURPOSEFUL ANGELS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 KOLL CENTER PKWY STE 250
PLEASANTON CA
94566-8062
US

IV. Provider business mailing address

333 DANBURY PL
LATHROP CA
95330-8877
US

V. Phone/Fax

Practice location:
  • Phone: 209-362-0425
  • Fax: 209-297-4319
Mailing address:
  • Phone: 510-910-4033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ADESUWA OLABANJI
Title or Position: OWNER
Credential: CSCM
Phone: 510-910-4033