Provider Demographics
NPI:1013574060
Name:MY ANGEL LLC
Entity Type:Organization
Organization Name:MY ANGEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-790-6819
Mailing Address - Street 1:4200 INDIAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-3006
Mailing Address - Country:US
Mailing Address - Phone:757-937-5686
Mailing Address - Fax:
Practice Address - Street 1:4200 INDIAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-3006
Practice Address - Country:US
Practice Address - Phone:757-937-5686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No347C00000XTransportation ServicesPrivate Vehicle