MEDICARE: AN ANGEL CARING

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	8333PCS-0	NV

General Provider Information

NPI Number	:	1205296753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AN ANGEL CARING

Provider Business Mailing Address
First Line	:	4805 NARA VISTA WAY UNIT 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4773
Country	:	US
Telephone Number	:	702-675-2753
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 NARA VISTA WAY UNIT 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4773
Country	:	US
Telephone Number	:	702-675-2753
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EIMA D MENDOZA SANDOVAL
Credential	:
Telephone Number	:	702-517-4683

Provider Enumeration Date	:	02/25/2016
Last Update Date	:	02/25/2016

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Directions to “AN ANGEL CARING ” Practice Location

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