=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265770127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY ANGELS HOME HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2013
-----------------------------------------------------
Last Update Date | 01/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5537 S MARTIN LUTHER KING JR BLVD
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48911-3563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-402-9220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5537 S MARTIN LUTHER KING JR BLVD
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48911-3563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-402-9220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. TARA STEWART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 517-402-9220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------