=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962955492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGEL HANDS HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2016
-----------------------------------------------------
Last Update Date | 08/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1353 E NAPIER AVE
-----------------------------------------------------
City | BENTON HARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49022-2133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-934-5117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 157
-----------------------------------------------------
City | BERRIEN SPRINGS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49103-0157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHAMONTAY D JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 269-876-0318
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------