=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568391449
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELS KINGDOM ASSISTED LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2026
-----------------------------------------------------
Last Update Date | 05/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 237 AZALEA DR
-----------------------------------------------------
City | WESTWEGO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70094-2209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-418-9666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 237 AZALEA DR
-----------------------------------------------------
City | WESTWEGO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70094-2209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CNA
-----------------------------------------------------
Name | MYRANIKA FRAZIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-418-9666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------