Healthcare Provider Details

I. General information

NPI: 1861780009
Provider Name (Legal Business Name): CIRCLE OF ANGELS HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E MAIN ST STE A302
SPARTANBURG SC
29307-1432
US

IV. Provider business mailing address

3005 VILLAGE PARK DR SUITE 204B
KNIGHTDALE NC
27545-7993
US

V. Phone/Fax

Practice location:
  • Phone: 864-579-3346
  • Fax: 919-217-0932
Mailing address:
  • Phone: 919-217-0933
  • Fax: 919-217-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DARRELL KENYATTA TENNIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-217-0933