=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912839911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGEL IN A SCRUB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2026
-----------------------------------------------------
Last Update Date | 06/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 HARVEY LN
-----------------------------------------------------
City | ORANGEBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29118-9208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-937-0059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 HARVEY LN
-----------------------------------------------------
City | ORANGEBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29118-9208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-937-0059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHANEKQUA WADE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-937-0059
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------