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General NPI Number Information
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NPI Number | 1942656194
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Entity Type | Organization
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Legal Business Name | ANGEL OF MINE HOME CARE LLC
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 223 ROCKWELL ST
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City | JACKSON
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State | MI
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Zip | 49203-3154
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Country | US
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Telephone | 517-358-4668
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4052
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City | JACKSON
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State | MI
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Zip | 49204-4052
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Country | US
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Telephone | 517-358-4668
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRANDEE SUE BENNETT
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Credential | CMA
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Telephone | 517-358-4668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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