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General NPI Number Information
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NPI Number | 1326899147
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Entity Type | Individual
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Provider Name | ANGELO GADDY
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Gender | Male
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 16540 WISCONSIN ST
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City | DETROIT
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State | MI
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Zip | 48221-2964
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Country | US
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Telephone | 313-671-4738
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WILDWOOD LN
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City | CANTON
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State | MI
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Zip | 48188-5080
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Country | US
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Telephone | 313-671-4738
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MI
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