=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114622859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELS OF LIGHT HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2023
-----------------------------------------------------
Last Update Date | 04/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 895 DOVE ST STE 300
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-2996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-640-1991
-----------------------------------------------------
Fax | 959-200-4101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 895 DOVE ST STE 300
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-2996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-640-1991
-----------------------------------------------------
Fax | 959-200-4101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NOLUSINDISO CANDICE KATIKATI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-640-1991
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------