=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669111027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASSIONATE ANGELS CAREGIVER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2022
-----------------------------------------------------
Last Update Date | 10/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 CHUCKWAGON CT
-----------------------------------------------------
City | ANGLETON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77515-2748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-545-3818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 CHUCKWAGON CT
-----------------------------------------------------
City | ANGLETON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77515-2748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-545-3818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. STACEY LYNN ALEXANDER-MCCOY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 979-709-1457
-----------------------------------------------------
=====================================================
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 | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------