Healthcare Provider Details

I. General information

NPI: 1154092104
Provider Name (Legal Business Name): CHARLEYS ANGELS HEALTHCARE NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MARTIN CT APT 232
BETHLEHEM PA
18018-2563
US

IV. Provider business mailing address

1345 MARTIN CT APT 232
BETHLEHEM PA
18018-2563
US

V. Phone/Fax

Practice location:
  • Phone: 610-228-2847
  • Fax:
Mailing address:
  • Phone: 718-598-3077
  • Fax: 855-589-3052

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 Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: EBONY BUSSEY
Title or Position: CEO
Credential:
Phone: 347-551-9268