Provider Demographics
NPI:1528216579
Name:EARTH ANGELS HOME CARE LLC
Entity Type:Organization
Organization Name:EARTH ANGELS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-539-4835
Mailing Address - Street 1:9741 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1325
Mailing Address - Country:US
Mailing Address - Phone:440-539-4835
Mailing Address - Fax:
Practice Address - Street 1:9741 CEDARWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1325
Practice Address - Country:US
Practice Address - Phone:440-539-4835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005010X279251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health