MEDICARE: ANGELINE HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1689131922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELINE HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1305 W BULLARD AVE STE 3
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-2469
Country	:	US
Telephone Number	:	559-779-4663
Fax Number	:	559-492-1787

Provider Business Practice Location Address
First Line	:	1305 W BULLARD AVE STE 3
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-2469
Country	:	US
Telephone Number	:	559-779-4663
Fax Number	:	559-492-1787

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TRINIDAD LIU
Credential	:
Telephone Number	:	559-283-3790

Provider Enumeration Date	:	02/22/2019
Last Update Date	:	02/22/2019

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