Healthcare Provider Details

I. General information

NPI: 1578361234
Provider Name (Legal Business Name): ETHELS ANGELS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14224 GRANDVILLE AVE
DETROIT MI
48223-2900
US

IV. Provider business mailing address

14224 GRANDVILLE AVE
DETROIT MI
48223-2900
US

V. Phone/Fax

Practice location:
  • Phone: 313-718-0132
  • Fax:
Mailing address:
  • Phone: 313-718-0132
  • 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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: LATIA SADE LINDSEY
Title or Position: MANAGER
Credential:
Phone: 313-718-0132