Healthcare Provider Details

I. General information

NPI: 1013574060
Provider Name (Legal Business Name): MY ANGEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 INDIAN RIVER RD
CHESAPEAKE VA
23325-3006
US

IV. Provider business mailing address

4200 INDIAN RIVER RD
CHESAPEAKE VA
23325-3006
US

V. Phone/Fax

Practice location:
  • Phone: 757-937-5686
  • Fax:
Mailing address:
  • Phone: 757-937-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: ANGELA MILTON
Title or Position: OWNER
Credential:
Phone: 757-790-6819