MEDICARE: ANGEL ELITE SERVICE 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	:	1841941408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL ELITE SERVICE INC

Provider Business Mailing Address
First Line	:	12114 BARWEN CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-1565
Country	:	US
Telephone Number	:	704-649-4711
Fax Number	:	866-502-3629

Provider Business Practice Location Address
First Line	:	12114 BARWEN CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-1565
Country	:	US
Telephone Number	:	704-649-4711
Fax Number	:	866-502-3629

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	LANDREA RICHARDSON
Credential	:	MBA MPA
Telephone Number	:	704-649-4711

Provider Enumeration Date	:	01/15/2022
Last Update Date	:	01/15/2022

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Directions to “ANGEL ELITE SERVICE INC ” Practice Location

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