Healthcare Provider Details

I. General information

NPI: 1265046981
Provider Name (Legal Business Name): ANGELS OF LIFE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 04/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BAKER RD STE 103
VIRGINIA BEACH VA
23462-1077
US

IV. Provider business mailing address

700 BAKER RD STE 103
VIRGINIA BEACH VA
23462-1077
US

V. Phone/Fax

Practice location:
  • Phone: 757-609-8031
  • Fax: 757-490-0353
Mailing address:
  • Phone: 757-609-8031
  • Fax: 757-490-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NICOLE HALIDAY
Title or Position: OWNER/DIRECTOR OF NURSING
Credential:
Phone: 757-698-9069