Healthcare Provider Details

I. General information

NPI: 1780238394
Provider Name (Legal Business Name): MICHAELAS ANGELIC CAREGIVERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 ST ANDREWS RD BLDG D SUITE 3A
COLUMBIA SC
29210-4486
US

IV. Provider business mailing address

455 ST ANDREWS RD BLDG D SUITE 3A
COLUMBIA SC
29210-4486
US

V. Phone/Fax

Practice location:
  • Phone: 803-497-3120
  • Fax: 803-497-3120
Mailing address:
  • Phone: 803-497-3120
  • Fax: 803-497-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. TASHARA HEYWARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-497-3120