MEDICARE: ANGELA LOUISE DAVIS

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		OH

General Provider Information

NPI Number	:	1376257261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA LOUISE DAVIS

Provider Business Mailing Address
First Line	:	3631 NEW CUMBERLAND RD NE
Second Line	:
City	:	MINERAL CITY
State	:	OH
Zip	:	44656-8807
Country	:	US
Telephone Number	:	606-305-1556
Fax Number	:

Provider Business Practice Location Address
First Line	:	3631 NEW CUMBERLAND RD NE
Second Line	:
City	:	MINERAL CITY
State	:	OH
Zip	:	44656-8807
Country	:	US
Telephone Number	:	606-305-1556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	01/06/2023

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