=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659815405
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGEL HOME CARE AGENCY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2016
-----------------------------------------------------
Last Update Date | 12/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1422 HYLAN BLVD 2ND FLOOR
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10305-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-980-2273
-----------------------------------------------------
Fax | 718-351-1962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1422 HYLAN BLVD 2ND FLOOR
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10305-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-980-2273
-----------------------------------------------------
Fax | 718-351-1962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MISS VERONIKA GAYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 346-257-0381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2187L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------