MEDICARE: EARTH ANGELS HEALTH & WELLNESS, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1184349185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARTH ANGELS HEALTH & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 28585
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-8585
Country	:	US
Telephone Number	:	904-729-5242
Fax Number	:	904-765-3155

Provider Business Practice Location Address
First Line	:	10177 LANCASHIRE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-4367
Country	:	US
Telephone Number	:	904-729-5242
Fax Number	:	904-765-3155

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	LEGA K LONG
Credential	:	MS
Telephone Number	:	904-729-5242

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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