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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1164676557
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	:

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	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. VERONICA MCLENDON
Credential	:
Telephone Number	:	704-596-0162

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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

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