=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033852090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH ANGELS HOME HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2022
-----------------------------------------------------
Last Update Date | 04/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 ARLINGTON AVE
-----------------------------------------------------
City | UPPER DARBY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19082-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-338-5778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 ARLINGTON AVE
-----------------------------------------------------
City | UPPER DARBY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19082-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-338-5778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HAJA W KOROMA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-338-5778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------