MEDICARE: ANGELIC SOLUTIONS HOME HEALTHCARE, INC.

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

General Provider Information

NPI Number	:	1346476744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC SOLUTIONS HOME HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	17011 BEACH BLVD
Second Line	:	SUITE 900
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5946
Country	:	US
Telephone Number	:	714-846-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	17011 BEACH BLVD
Second Line	:	SUITE 900
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5946
Country	:	US
Telephone Number	:	714-846-5353
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DONNA KAYE HICKMAN
Credential	:
Telephone Number	:	714-846-5353

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	06/01/2009

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