MEDICARE: MEJC ANGELS LLC DBA VISITING ANGELS

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	NR30211468	FL

General Provider Information

NPI Number	:	1639478886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEJC ANGELS LLC DBA VISITING ANGELS

Provider Business Mailing Address
First Line	:	1931 NW 150TH AVE STE 123
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2873
Country	:	US
Telephone Number	:	954-241-1048
Fax Number	:	954-281-8893

Provider Business Practice Location Address
First Line	:	1931 NW 150TH AVE STE 123
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2873
Country	:	US
Telephone Number	:	954-241-1048
Fax Number	:	954-281-8893

Authorized Official
Title or Position	:	DIRECTOR/CFO
Name	:	EDITH CHARPENTIER
Credential	:
Telephone Number	:	954-241-1048

Provider Enumeration Date	:	03/26/2011
Last Update Date	:	03/26/2011

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