MEDICARE: CHARLIE'S ANGELS HOME HEALTH CARE AGENCY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	163WH0200X	Home Health Registered Nurse
3	251E00000X	Home Health Agency
4	253Z00000X	In Home Supportive Care Agency
5	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1225790629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLIE'S ANGELS HOME HEALTH CARE AGENCY

Provider Business Mailing Address
First Line	:	1214 BOTTLE BRUSH LN
Second Line	:
City	:	HARRISBURG
State	:	NC
Zip	:	28075-6715
Country	:	US
Telephone Number	:	412-977-1273
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S MCDOWELL ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2623
Country	:	US
Telephone Number	:	704-918-7966
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CARLITA RANDALL
Credential	:
Telephone Number	:	412-977-1273

Provider Enumeration Date	:	10/13/2021
Last Update Date	:	10/05/2022

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