Healthcare Provider Details

I. General information

NPI: 1689066342
Provider Name (Legal Business Name): ANGELUS HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 GRANT ST
REYNOLDSVILLE PA
15851-1417
US

IV. Provider business mailing address

911 GRANT ST
REYNOLDSVILLE PA
15851-1417
US

V. Phone/Fax

Practice location:
  • Phone: 814-771-6983
  • Fax: 814-653-8200
Mailing address:
  • Phone: 814-771-6983
  • Fax: 814-653-8200

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: JASON SROCK
Title or Position: OWNER
Credential:
Phone: 814-771-6983