MEDICARE: ANGEL'S OF JOY HOME HEALTH, 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	5758PCS-3	NV

General Provider Information

NPI Number	:	1871892521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL'S OF JOY HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	2235 E FLAMINGO RD
Second Line	:	SUITE # 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5129
Country	:	US
Telephone Number	:	702-893-3011
Fax Number	:	702-893-3012

Provider Business Practice Location Address
First Line	:	2235 E FLAMINGO RD
Second Line	:	SUITE # 107
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5129
Country	:	US
Telephone Number	:	702-893-3011
Fax Number	:	702-893-3012

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	KANDICE L ASHY FERNSTROM
Credential	:
Telephone Number	:	901-494-0666

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/21/2011

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