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General NPI Number Information
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NPI Number | 1740852573
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Entity Type | Organization
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Legal Business Name | LYDIA ANGELS AT HOME LLC
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 287 GROVE ST, BUILDING D SUITE 204, ROOM NO. 275
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City | WORCESTER
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State | MA
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Zip | 01605-3905
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Country | US
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Telephone | 774-329-6133
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Fax | 978-514-7222
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Provider Business Mailing Address
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Address Line | 499 MECHANIC ST
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City | LEOMINSTER
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State | MA
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Zip | 01453-4431
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Country | US
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Telephone | 774-329-6133
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Fax | 978-514-7222
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Authorized Official
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Title or Position | OWNER
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Name | LYDIA A MOKOENA
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Credential |
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Telephone | 774-329-6133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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