Healthcare Provider Details

I. General information

NPI: 1396126033
Provider Name (Legal Business Name): ROSEMARY'S ANGELS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 300 N
ANDERSON IN
46012-1202
US

IV. Provider business mailing address

220 S PENDLETON AVE
PENDLETON IN
46064-1106
US

V. Phone/Fax

Practice location:
  • Phone: 765-778-3434
  • Fax: 765-778-6969
Mailing address:
  • Phone: 765-778-3434
  • Fax: 765-778-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number140124941
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ADONICA ELLIS
Title or Position: PRESIDENT
Credential:
Phone: 765-778-3434