MEDICARE: KJ ANGEL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	253Z00000X	In Home Supportive Care Agency
3	385H00000X	Respite Care
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1225531288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KJ ANGEL SERVICES, LLC

Provider Business Mailing Address
First Line	:	3133 FLOYD BLVD STE B
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51108-1419
Country	:	US
Telephone Number	:	712-899-9575
Fax Number	:

Provider Business Practice Location Address
First Line	:	3133 FLOYD BLVD STE B
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51108-1419
Country	:	US
Telephone Number	:	712-899-9575
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	JEFF HAMMERSTROM
Credential	:
Telephone Number	:	712-899-9575

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	03/15/2018

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