MEDICARE: DIANE'S ANGELS HOME HEALTH 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1154992444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANE'S ANGELS HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	1852 NASON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1678
Country	:	US
Telephone Number	:	614-390-6379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1852 NASON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1678
Country	:	US
Telephone Number	:	614-390-6379
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KOSETTE HARDY
Credential	:
Telephone Number	:	614-444-5544

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

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