MEDICARE: ANGEL STAR HOME HEALTH, INC.

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	3747P1801X	Personal Care Attendant
2	163WC1500X	Community Health Registered Nurse
3	163WH0200X	Home Health Registered Nurse
4	163WI0500X	Infusion Therapy Registered Nurse
5	251E00000X	Home Health Agency
6	332B00000X	Durable Medical Equipment & Medical Supplies	332B00000X	NC
7	374U00000X	Home Health Aide
8	376K00000X	Nurse's Aide
9	163W00000X	Registered Nurse

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114948031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL STAR HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	9816 NOTTINGHILL LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-5006
Country	:	US
Telephone Number	:	704-596-0162
Fax Number	:	704-596-0869

Provider Business Practice Location Address
First Line	:	5100 REAGAN DR
Second Line	:	SUITE 15
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-3190
Country	:	US
Telephone Number	:	704-596-0162
Fax Number	:	704-596-0869

Authorized Official
Title or Position	:	VICE PRESIDENT OF OPERATIONS
Name	:	MRS. VERONICA LAVON MCLENDON
Credential	:
Telephone Number	:	704-596-0162

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	06/29/2009

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Directions to “ANGEL STAR HOME HEALTH, INC. ” Practice Location

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