Healthcare Provider Details

I. General information

NPI: 1295494730
Provider Name (Legal Business Name): ANGELIC VISITING NURSES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7221 MANSFIELD AVE
PHILADELPHIA PA
19138-1620
US

IV. Provider business mailing address

7221 MANSFIELD AVE
PHILADELPHIA PA
19138-1620
US

V. Phone/Fax

Practice location:
  • Phone: 267-454-3731
  • Fax:
Mailing address:
  • Phone: 267-454-3731
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: QUADDRIAH M MOORE-SMITH
Title or Position: RN,BSN
Credential: REGISTERED NURSE
Phone: 267-454-3731