=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477336659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCHANGELS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2023
-----------------------------------------------------
Last Update Date | 01/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3959 ELECTRIC RD
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-4562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-904-7104
-----------------------------------------------------
Fax | 540-206-3857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1320 3RD ST SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24016-5219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-266-7800
-----------------------------------------------------
Fax | 540-266-7800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE COORDINATOR
-----------------------------------------------------
Name | MRS. STACY BUSH PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-904-7104
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------