Healthcare Provider Details

I. General information

NPI: 1477233195
Provider Name (Legal Business Name): ANGELIC ASSISTANCE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23856 MCCALL ST
SOUTHFIELD MI
48033-5258
US

IV. Provider business mailing address

23856 MCCALL ST
SOUTHFIELD MI
48033-5258
US

V. Phone/Fax

Practice location:
  • Phone: 313-643-9464
  • Fax:
Mailing address:
  • Phone: 313-643-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANGELIQUE NOBLE-JOHNSON
Title or Position: OWNER
Credential:
Phone: 313-643-9464