MEDICARE: COACHELLA VALLEY ANGELS, 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	376J00000X	Homemaker
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1174478226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COACHELLA VALLEY ANGELS, INC.

Provider Business Mailing Address
First Line	:	43875 WASHINGTON ST STE H
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-8249
Country	:	US
Telephone Number	:	760-404-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	43875 WASHINGTON ST STE H
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-8249
Country	:	US
Telephone Number	:	760-404-0220
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SARA BRIDGEWATER
Credential	:
Telephone Number	:	859-202-1049

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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