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General NPI Number Information
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NPI Number | 1215580592
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Entity Type | Organization
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Legal Business Name | HOLY ANGEL HOME CARE LLC
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 9313 KREWSTOWN RD
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3710
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Country | US
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Telephone | 215-673-7373
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Fax | 215-673-7370
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Provider Business Mailing Address
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Address Line | 11 SUNFLOWER WAY
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-5450
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Country | US
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Telephone | 267-760-4417
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Fax | 215-673-7370
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | MR. DEVASSYKUTTY K VAREED
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Credential | RPH
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Telephone | 267-760-4417
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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 |
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