Provider Demographics
NPI:1558034470
Name:BELL'S ANGELS HOMECARE SERVICES, LLC
Entity Type:Organization
Organization Name:BELL'S ANGELS HOMECARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:980-200-7909
Mailing Address - Street 1:11004 DIPALI CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-7664
Mailing Address - Country:US
Mailing Address - Phone:980-200-7909
Mailing Address - Fax:
Practice Address - Street 1:5736 N TRYON ST STE 225D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-0824
Practice Address - Country:US
Practice Address - Phone:980-498-4163
Practice Address - Fax:980-355-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care