MEDICARE: SHIRLEY'S ANGELS HOME CARE, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588401897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIRLEY'S ANGELS HOME CARE, LLC

Provider Business Mailing Address
First Line	:	3901 W 86TH ST STE 360-304
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-5734
Country	:	US
Telephone Number	:	317-644-2249
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 W 86TH ST STE 360-304
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-5734
Country	:	US
Telephone Number	:	317-644-2249
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHONTE' S WILLIAMS
Credential	:
Telephone Number	:	317-644-2249

Provider Enumeration Date	:	07/12/2024
Last Update Date	:	10/30/2024

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