Healthcare Provider Details

I. General information

NPI: 1740852573
Provider Name (Legal Business Name): LYDIA ANGELS AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 GROVE ST, BUILDING D SUITE 204, ROOM NO. 275
WORCESTER MA
01605-3905
US

IV. Provider business mailing address

499 MECHANIC ST
LEOMINSTER MA
01453-4431
US

V. Phone/Fax

Practice location:
  • Phone: 774-329-6133
  • Fax: 978-514-7222
Mailing address:
  • Phone: 774-329-6133
  • Fax: 978-514-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LYDIA A MOKOENA
Title or Position: OWNER
Credential:
Phone: 774-329-6133