MEDICARE: ANGELS CARE NURSING 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	385H00000X	Respite Care	24005415	CA

General Provider Information

NPI Number	:	1609922012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS CARE NURSING SERVICES, INC.

Provider Business Mailing Address
First Line	:	13663 PRAIRIE AVE
Second Line	:	SUITE D
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-7372
Country	:	US
Telephone Number	:	310-675-6767
Fax Number	:	310-675-6737

Provider Business Practice Location Address
First Line	:	13663 PRAIRIE AVE
Second Line	:	SUITE D
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-7372
Country	:	US
Telephone Number	:	310-675-6767
Fax Number	:	310-675-6737

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. THERESA ADUBA
Credential	:	RN
Telephone Number	:	310-675-6767

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	08/22/2020

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