MEDICARE: ANGELFAITH PEDIATRIC HOME HEALTH CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	385HR2065X	Child Physical Disabilities Respite Care
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency
4	251C00000X	Developmentally Disabled Services Day Training Agency
5	3747P1801X	Personal Care Attendant
6	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
7	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1912543018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELFAITH PEDIATRIC HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	17703 CYPRESS HILL DR
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-8266
Country	:	US
Telephone Number	:	281-369-0690
Fax Number	:	833-877-1558

Provider Business Practice Location Address
First Line	:	17703 CYPRESS HILL DR
Second Line	:
City	:	ROSHARON
State	:	TX
Zip	:	77583-8266
Country	:	US
Telephone Number	:	281-369-0690
Fax Number	:	833-877-1558

Authorized Official
Title or Position	:	ADMINISTRATOR/MANAGING MEMBER
Name	:	DONSHANEICE MECHELLE BROWN
Credential	:
Telephone Number	:	832-800-5729

Provider Enumeration Date	:	11/23/2019
Last Update Date	:	07/19/2023

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