MEDICARE: ANGELS IN WAITING HEALTHCARE PROVIDERS, 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	251E00000X	Home Health Agency	2317558	OH

General Provider Information

NPI Number	:	1699171553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS IN WAITING HEALTHCARE PROVIDERS, LLC

Provider Business Mailing Address
First Line	:	8324 TYLER BLVD
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4221
Country	:	US
Telephone Number	:	440-205-8278
Fax Number	:	440-205-8277

Provider Business Practice Location Address
First Line	:	8324 TYLER BLVD
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4221
Country	:	US
Telephone Number	:	440-205-8278
Fax Number	:	440-205-8277

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JENNIFER JOCHUM
Credential	:
Telephone Number	:	440-205-8278

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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