MEDICARE: ANGELUS HOME HEALTHCARE, 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	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency		IL

General Provider Information

NPI Number	:	1942566278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELUS HOME HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	123 W WASHINGTON ST
Second Line	:	SUITE 330
City	:	OSWEGO
State	:	IL
Zip	:	60543-8214
Country	:	US
Telephone Number	:	630-791-9061
Fax Number	:	800-317-5711

Provider Business Practice Location Address
First Line	:	123 W WASHINGTON ST
Second Line	:	SUITE 330
City	:	OSWEGO
State	:	IL
Zip	:	60543-8214
Country	:	US
Telephone Number	:	630-791-9061
Fax Number	:	800-317-5711

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	AKSHAY PATEL
Credential	:
Telephone Number	:	630-791-9061

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	02/24/2014

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