MEDICARE: ANGELS OF ST. CLAIR, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	251E00000X	Home Health Agency
3	385H00000X	Respite Care
4	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1114484854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS OF ST. CLAIR, INC.

Provider Business Mailing Address
First Line	:	1530 PINE GROVE AVE STE 7
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3370
Country	:	US
Telephone Number	:	810-966-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 PINE GROVE AVE STE 7
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3370
Country	:	US
Telephone Number	:	810-966-2273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN NOVAK
Credential	:
Telephone Number	:	586-726-6999

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	03/01/2019

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