MEDICARE: ACCLAIMED ANGELIC HEALTHCARE SERVICES 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	251E00000X	Home Health Agency
2	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1407513336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCLAIMED ANGELIC HEALTHCARE SERVICES INC.

Provider Business Mailing Address
First Line	:	1131 KEPLERS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2052
Country	:	US
Telephone Number	:	832-288-1477
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 KEPLERS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2052
Country	:	US
Telephone Number	:	832-288-1477
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CHINEDU CHRISTOPHER MOKOLO JR.
Credential	:
Telephone Number	:	832-288-1477

Provider Enumeration Date	:	11/28/2021
Last Update Date	:	11/28/2021

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