MEDICARE: ANGELIC TOUCH AND WELLNESS CENTER 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	363LG0600X	Gerontology Nurse Practitioner

General Provider Information

NPI Number	:	1811737737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC TOUCH AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	1605 TEAKWOOD DR
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-8182
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9304 FOREST LN STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-6262
Country	:	US
Telephone Number	:	908-347-9939
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DOROTHY OJINNAKA
Credential	:
Telephone Number	:	908-347-9939

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	07/23/2024

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