MEDICARE: ANGEL'S ADULT DAYCARE CENTER 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1235608373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL'S ADULT DAYCARE CENTER LLC

Provider Business Mailing Address
First Line	:	430 N MAIN ST
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4425
Country	:	US
Telephone Number	:	757-334-0474
Fax Number	:	757-934-2042

Provider Business Practice Location Address
First Line	:	1530 LAKE SPEIGHT DR
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-6029
Country	:	US
Telephone Number	:	757-934-2042
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTATOR
Name	:	JOANNE CALVIE
Credential	:
Telephone Number	:	757-334-0474

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	03/04/2026

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