=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174873756
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELS HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2012
-----------------------------------------------------
Last Update Date | 06/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29970 TECHNOLOGY DR SUITE 208
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-2645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-691-5001
-----------------------------------------------------
Fax | 951-691-5003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29970 TECHNOLOGY DR SUITE 208
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-2645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-691-5001
-----------------------------------------------------
Fax | 951-691-5003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | KELLY A SMITH
-----------------------------------------------------
Credential | LVN BS
-----------------------------------------------------
Telephone | 958-691-5001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------