MEDICARE: AGING ANGELS 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	253Z00000X	In Home Supportive Care Agency	1997208	IL

General Provider Information

NPI Number	:	1295027779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGING ANGELS LLC

Provider Business Mailing Address
First Line	:	2585 SYCAMORE RD
Second Line	:
City	:	DEKALB
State	:	IL
Zip	:	60115-2051
Country	:	US
Telephone Number	:	815-754-1300
Fax Number	:	815-754-1500

Provider Business Practice Location Address
First Line	:	2585 SYCAMORE RD
Second Line	:
City	:	DEKALB
State	:	IL
Zip	:	60115-2051
Country	:	US
Telephone Number	:	815-754-1300
Fax Number	:	815-754-1500

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WAYNE R SLAGLE
Credential	:
Telephone Number	:	815-754-1300

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	05/03/2011

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