MEDICARE: COMPASSIONATE ANGELS HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LF0000X	Family Nurse Practitioner
2	363LP2300X	Primary Care Nurse Practitioner
3	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1649996844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE ANGELS HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	2320 IVERSON ST STE 200
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6801
Country	:	US
Telephone Number	:	240-788-7439
Fax Number	:	240-619-2862

Provider Business Practice Location Address
First Line	:	2320 IVERSON ST STE 200
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6801
Country	:	US
Telephone Number	:	240-788-7439
Fax Number	:	240-619-2862

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	ESTHER OZOR
Credential	:	NURSE PRACTITIONER
Telephone Number	:	240-788-7439

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	10/19/2022

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