MEDICARE: ANGELS OF LOVE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1285977249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS OF LOVE LLC

Provider Business Mailing Address
First Line	:	21931 GARDNER ST
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-2683
Country	:	US
Telephone Number	:	248-796-8004
Fax Number	:	248-808-6052

Provider Business Practice Location Address
First Line	:	21931 GARDNER ST
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-2683
Country	:	US
Telephone Number	:	248-796-8004
Fax Number	:	248-808-6052

Authorized Official
Title or Position	:	PRESIDENT ADMINISTRATOR
Name	:	MS. SHAWNELL CLARK
Credential	:
Telephone Number	:	248-796-8004

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	07/22/2014

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