=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285371245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN-HOME ANGELS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2022
-----------------------------------------------------
Last Update Date | 05/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 NEW HAVEN RD STE D
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06483-3460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-463-8860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 NEW HAVEN RD STE D
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06483-3460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-463-8860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JO-BETH FOLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-808-8727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------