Healthcare Provider Details

I. General information

NPI: 1740844422
Provider Name (Legal Business Name): ANGELA RENEE'S HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2398 CORY CT
OCOEE FL
34761
US

IV. Provider business mailing address

PO BOX 682334
ORLANDO FL
32868-2334
US

V. Phone/Fax

Practice location:
  • Phone: 847-445-0538
  • Fax: 800-479-9091
Mailing address:
  • Phone: 847-445-0538
  • Fax: 800-479-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MRS. DARLENE MICHELE KENNARD
Title or Position: OWNER/PRESIDENT
Credential: RN
Phone: 847-445-0538