MEDICARE: PROFESSIONAL ANGEL CARE, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	3000440	IL

General Provider Information

NPI Number	:	1003210295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL ANGEL CARE, LTD.

Provider Business Mailing Address
First Line	:	3525 W. PETERSON AVENUE
Second Line	:	SUITE 222
City	:	CHICAGO
State	:	IL
Zip	:	60659-3314
Country	:	US
Telephone Number	:	773-907-8991
Fax Number	:	773-907-8992

Provider Business Practice Location Address
First Line	:	3525 W. PETERSON AVENUE
Second Line	:	SUITE 222
City	:	CHICAGO
State	:	IL
Zip	:	60659-3314
Country	:	US
Telephone Number	:	773-907-8991
Fax Number	:	773-907-8992

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. MANOLITO DEL ROSARIO GAWAT
Credential	:
Telephone Number	:	773-907-8991

Provider Enumeration Date	:	10/16/2014
Last Update Date	:	10/16/2014

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