MEDICARE: ANGELIC HANDS HOME CARE OF OHIO LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	373H00000X	Day Training/Habilitation Specialist
3	376J00000X	Homemaker
4	376K00000X	Nurse's Aide
5	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1225630916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC HANDS HOME CARE OF OHIO LLC

Provider Business Mailing Address
First Line	:	5129 KINGSFORD DR
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-1925
Country	:	US
Telephone Number	:	937-219-6543
Fax Number	:

Provider Business Practice Location Address
First Line	:	5129 KINGSFORD DR
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-1925
Country	:	US
Telephone Number	:	937-219-6543
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MS. APRIL LYNNE JONES
Credential	:	LPN
Telephone Number	:	937-219-6543

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	11/09/2020

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