=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730481276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELS OF LOVE CAREGIVER SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2010
-----------------------------------------------------
Last Update Date | 12/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2824 VANSTORY ST APT 1C 2824-1C-VANSTROY ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407-4782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-558-1587
-----------------------------------------------------
Fax | 336-617-3969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2824 VANSTORY ST APT 1C 2824-1C-VANSTROY ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407-4782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-558-1587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS TYRANN WILLIAMS
-----------------------------------------------------
Credential | 12/09/1957
-----------------------------------------------------
Telephone | 336-558-1587
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------