MEDICARE: ANGELS OF LOVE CAREGIVER SERVICE

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		NC

General Provider Information

NPI Number	:	1730481276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS OF LOVE CAREGIVER SERVICE

Provider Business Mailing Address
First Line	:	2824 VANSTORY ST APT 1C
Second Line	:	2824-1C-VANSTROY ST
City	:	GREENSBORO
State	:	NC
Zip	:	27407-4782
Country	:	US
Telephone Number	:	336-558-1587
Fax Number	:

Provider Business Practice Location Address
First Line	:	2824 VANSTORY ST APT 1C
Second Line	:	2824-1C-VANSTROY ST
City	:	GREENSBORO
State	:	NC
Zip	:	27407-4782
Country	:	US
Telephone Number	:	336-558-1587
Fax Number	:	336-617-3969

Authorized Official
Title or Position	:	OWNER
Name	:	MISS TYRANN WILLIAMS
Credential	:	12/09/1957
Telephone Number	:	336-558-1587

Provider Enumeration Date	:	12/02/2010
Last Update Date	:	12/02/2010

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