Healthcare Provider Details

I. General information

NPI: 1477996478
Provider Name (Legal Business Name): ANGEL ARMS NON MEDICAL & HOME HEALTH SVC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 1ST ST W
HAMPTON SC
29924-3404
US

IV. Provider business mailing address

310 1ST ST W
HAMPTON SC
29924-3404
US

V. Phone/Fax

Practice location:
  • Phone: 803-943-5062
  • Fax: 803-943-2156
Mailing address:
  • Phone: 803-943-5062
  • Fax: 803-943-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: LINDA WHITE MYERS
Title or Position: CEO
Credential:
Phone: 803-943-5062