Healthcare Provider Details

I. General information

NPI: 1982901369
Provider Name (Legal Business Name): ANGEL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2011
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6551 STAGE OAKS DR 3B
BARTLETT TN
38134-3895
US

IV. Provider business mailing address

6551 STAGE OAKS DR 3B
BARTLETT TN
38134-3895
US

V. Phone/Fax

Practice location:
  • Phone: 901-389-0319
  • Fax:
Mailing address:
  • Phone: 901-389-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number111000798
License Number StateTN

VIII. Authorized Official

Name: MS. ANGEL LEVETTE WILLIAMS
Title or Position: OWNER
Credential:
Phone: 901-859-8828