=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841703121
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGEL CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2017
-----------------------------------------------------
Last Update Date | 09/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 485 KINGS HWY STE 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11223-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-507-7500
-----------------------------------------------------
Fax | 917-507-7501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 485 KINGS HWY STE 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11223-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-507-7500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MARINA PIAVSKAIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-507-7500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1903L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------