MEDICARE: A1 ANGEL SENIOR CARE CORP

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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1487342937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A1 ANGEL SENIOR CARE CORP

Provider Business Mailing Address
First Line	:	49 N FEDERAL HWY # 305
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-4304
Country	:	US
Telephone Number	:	549-644-3142
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 GALT OCEAN DR APT 8S
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6113
Country	:	US
Telephone Number	:	954-644-3142
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. RENAE L YANERO
Credential	:	RN
Telephone Number	:	954-644-3142

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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