=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689151912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EARTH ANGELS HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2018
-----------------------------------------------------
Last Update Date | 07/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 167 MACARTHUR ST.
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-588-2178
-----------------------------------------------------
Fax | 336-625-0185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 167 MACARTHUR ST.
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-588-2178
-----------------------------------------------------
Fax | 336-625-0185
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSING SUPERVISOR
-----------------------------------------------------
Name | MR. RICHARD JOHN GARDNER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 336-588-2178
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------