=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851556039
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE ANGELS HOME HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2008
-----------------------------------------------------
Last Update Date | 07/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2167 MOHEGAN DR
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22043-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 186-650-3432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2167 MOHEGAN DR
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22043-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 186-650-3432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. LEEA LORAINE LYNCH
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 18665034321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 0851644
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------