MEDICARE: ANGEL WINGS HOME CARE LLC

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
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1073260329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL WINGS HOME CARE LLC

Provider Business Mailing Address
First Line	:	1100 MERIDIAN BAY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1625
Country	:	US
Telephone Number	:	702-772-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 MERIDIAN BAY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1625
Country	:	US
Telephone Number	:	702-772-2266
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANISA HARRIS
Credential	:
Telephone Number	:	702-772-2266

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	10/02/2022

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Directions to “ANGEL WINGS HOME CARE LLC ” Practice Location

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