MEDICARE: HEARTS OF ANGELS AGENCY 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	343900000X	Non-emergency Medical Transport (VAN)
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1801220033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTS OF ANGELS AGENCY LLC

Provider Business Mailing Address
First Line	:	16360 BROADWAY AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2555
Country	:	US
Telephone Number	:	216-952-4838
Fax Number	:

Provider Business Practice Location Address
First Line	:	16360 BROADWAY AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2555
Country	:	US
Telephone Number	:	216-952-4838
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. SAMIRA A ROGERS
Credential	:
Telephone Number	:	216-952-4838

Provider Enumeration Date	:	08/23/2013
Last Update Date	:	08/23/2013

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