=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992529259
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELS OF COMPASSIONATE CARE HOMEHEALTH SITTERS REGISTRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2024
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2412 FOX FIELD RD
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70669-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-707-2913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2412 FOX FIELD RD
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70669-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-707-2913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | MRS. DIANNA MARIE JENKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-707-2913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------