MEDICARE: ANGELIC HANDS HOMECARE SERVICE LLC

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	:	1578237897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC HANDS HOMECARE SERVICE LLC

Provider Business Mailing Address
First Line	:	1204 E BASELINE RD STE 106
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 E BASELINE RD STE 106
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1447
Country	:	US
Telephone Number	:	602-704-5013
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DIONDRA HOWARD
Credential	:
Telephone Number	:	480-365-9186

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/02/2021

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