MEDICARE: LUCAS ANGELS

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	:	1346950243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCAS ANGELS

Provider Business Mailing Address
First Line	:	432 KINGSTON DR
Second Line	:
City	:	MC BEE
State	:	SC
Zip	:	29101-9568
Country	:	US
Telephone Number	:	843-319-7330
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 CARGILL WAY STE BA8
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-4260
Country	:	US
Telephone Number	:	843-309-9600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATOYA BRYANT LUCAS
Credential	:
Telephone Number	:	843-861-5197

Provider Enumeration Date	:	12/01/2022
Last Update Date	:	07/25/2025

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