MEDICARE: 3 ANGELS CAREGIVERS

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	310400000X	Assisted Living Facility	128009	TX

General Provider Information

NPI Number	:	1982996930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3 ANGELS CAREGIVERS

Provider Business Mailing Address
First Line	:	9754 AMBERLEY DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2303
Country	:	US
Telephone Number	:	214-575-3585
Fax Number	:

Provider Business Practice Location Address
First Line	:	9754 AMBERLEY DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2303
Country	:	US
Telephone Number	:	214-575-3585
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	NATIVIDAD CHIPANA
Credential	:	LVN
Telephone Number	:	214-575-3585

Provider Enumeration Date	:	05/10/2011
Last Update Date	:	05/10/2011

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