Healthcare Provider Details

I. General information

NPI: 1558553545
Provider Name (Legal Business Name): ANGEL SUPPORTIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 WEALTHY ST SE SUITE 270
GRAND RAPIDS MI
49506-2755
US

IV. Provider business mailing address

1514 WEALTHY ST SE SUITE 270
GRAND RAPIDS MI
49506-2755
US

V. Phone/Fax

Practice location:
  • Phone: 616-243-7080
  • Fax: 616-988-0171
Mailing address:
  • Phone: 616-243-7080
  • Fax: 616-988-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. PATRICIA L BORGDORFF
Title or Position: OWNER/DIRECTOR
Credential: MSW, ACSW
Phone: 616-243-7080