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General NPI Number Information
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NPI Number | 1598435695
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Entity Type | Organization
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Legal Business Name | CHARLIES ANGELS HEALTHCARE LLC
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 412 BEACH 38TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-1514
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Country | US
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Telephone | 610-619-6069
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Fax |
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Provider Business Mailing Address
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Address Line | 412 BEACH 38TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-1514
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Country | US
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Telephone | 718-598-3077
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Fax | 855-589-3052
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Authorized Official
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Title or Position | OWNER/CEO
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Name | EBONY BUSSEY
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Credential |
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Telephone | 718-598-3077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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