MEDICARE: ANGELS ON CALL HOMECARE AND MEDICAL STAFFING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	385H00000X	Respite Care
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1912765959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS ON CALL HOMECARE AND MEDICAL STAFFING LLC

Provider Business Mailing Address
First Line	:	5215 N IRONWOOD RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-4915
Country	:	US
Telephone Number	:	414-209-5579
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 N IRONWOOD RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-4915
Country	:	US
Telephone Number	:	414-209-5579
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHAQUAN SPARKS
Credential	:
Telephone Number	:	414-839-3309

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	03/12/2024

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