Healthcare Provider Details

I. General information

NPI: 1649666512
Provider Name (Legal Business Name): SOUTH COAST ANGELS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 ROCKDALE AVE
NEW BEDFORD MA
02740-2704
US

IV. Provider business mailing address

838 ROCKDALE AVE
NEW BEDFORD MA
02740-2704
US

V. Phone/Fax

Practice location:
  • Phone: 774-425-3083
  • Fax:
Mailing address:
  • Phone: 774-425-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number8378
License Number StateMA

VIII. Authorized Official

Name: GLENN WILLIAM MACHADO
Title or Position: OWNER
Credential:
Phone: 774-425-3083