=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679859417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERYDAY ANGELS HOME HEALTH CARELLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2011
-----------------------------------------------------
Last Update Date | 10/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3909 LELAND WAY
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83709-4603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-919-0034
-----------------------------------------------------
Fax | 208-629-5466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3909 LELAND WAY
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83709-4603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-919-0034
-----------------------------------------------------
Fax | 208-629-5466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. BRENDA LEE LAING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-919-0034
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 253Z00000X
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------