=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750688958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EARTH ANGELS HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2011
-----------------------------------------------------
Last Update Date | 02/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 SOUTHBRIDGE PKWY STE 650
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-414-7445
-----------------------------------------------------
Fax | 205-414-7400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 SOUTHBRIDGE PKWY STE 650
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-414-7445
-----------------------------------------------------
Fax | 205-414-7400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, CO-FOUNDER
-----------------------------------------------------
Name | SHELIA JOLLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-414-7445
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------