=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477819373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLESSED ANGELS PRIVATE CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2012
-----------------------------------------------------
Last Update Date | 04/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3026 TYRE NECK RD SUITE A
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23703-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-637-5582
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3026 TYRE NECK RD SUITE A
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-637-5582
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TERESA MARSHALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-638-0064
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------