MEDICARE: KC'S ANGELSINC.

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

General Provider Information

NPI Number	:	1083387864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KC'S ANGELSINC.

Provider Business Mailing Address
First Line	:	5821 FORT RD
Second Line	:
City	:	GREENWOOD
State	:	FL
Zip	:	32443-1957
Country	:	US
Telephone Number	:	850-209-0032
Fax Number	:

Provider Business Practice Location Address
First Line	:	5821 FORT RD
Second Line	:
City	:	GREENWOOD
State	:	FL
Zip	:	32443-1957
Country	:	US
Telephone Number	:	850-209-0032
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AVIA L DECREE
Credential	:
Telephone Number	:	850-209-0032

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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