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General NPI Number Information
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NPI Number | 1205749306
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Entity Type | Organization
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Legal Business Name | CHARLIES ANGELS HEALTHCARE LLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 4539 N 22ND ST STE N
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City | PHOENIX
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State | AZ
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Zip | 85016-4639
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Country | US
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Telephone | 718-598-3077
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Fax | 855-589-3052
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Provider Business Mailing Address
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Address Line | 4539 N 22ND ST STE N
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City | PHOENIX
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State | AZ
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Zip | 85016-4639
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Country | US
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Telephone | 718-598-3077
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Fax | 855-589-3052
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | EBONY BUSSEY
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Credential |
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Telephone | 718-598-3077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State | NULL
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