Provider Demographics
NPI:1326645862
Name:ANGEL HEARTS CO. LLC
Entity Type:Organization
Organization Name:ANGEL HEARTS CO. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADWELL
Authorized Official - Middle Name:LEROME
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:843-845-5588
Mailing Address - Street 1:3656 S IRBY ST STE C
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-5225
Mailing Address - Country:US
Mailing Address - Phone:843-845-5588
Mailing Address - Fax:
Practice Address - Street 1:3656 S IRBY ST STE C
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-5225
Practice Address - Country:US
Practice Address - Phone:843-845-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty