MEDICARE: ANGELA WOMACK

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	:	1144040387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WOMACK

Provider Business Mailing Address
First Line	:	5401 SE RICE LN
Second Line	:
City	:	AMITY
State	:	OR
Zip	:	97101-2306
Country	:	US
Telephone Number	:	972-978-1144
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 SE RICE LN
Second Line	:
City	:	AMITY
State	:	OR
Zip	:	97101-2306
Country	:	US
Telephone Number	:	972-978-1144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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Directions to “ ANGELA WOMACK ” Practice Location

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