MEDICARE: ANGEL HEARTS CO. 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1326645862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL HEARTS CO. LLC

Provider Business Mailing Address
First Line	:	3656 S IRBY ST STE C
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29505-5225
Country	:	US
Telephone Number	:	843-845-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	3656 S IRBY ST STE C
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29505-5225
Country	:	US
Telephone Number	:	843-845-5588
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADWELL LEROME SCOTT SR.
Credential	:
Telephone Number	:	843-845-5588

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	10/13/2020

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Directions to “ANGEL HEARTS CO. LLC ” Practice Location

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