Healthcare Provider Details

I. General information

NPI: 1689495244
Provider Name (Legal Business Name): PEACEFUL ANGELS HOMECARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 ADDISON RD STE 101
WINDSOR CT
06095-2179
US

IV. Provider business mailing address

175 ADDISON RD STE 101
WINDSOR CT
06095-2179
US

V. Phone/Fax

Practice location:
  • Phone: 860-640-0076
  • Fax:
Mailing address:
  • Phone: 860-640-0076
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ISSIFU ISSAKA
Title or Position: EXECUTIVE DIRECTOR
Credential: MSC. (HON) ECONOMICS
Phone: 203-507-8576