Provider Demographics
NPI:1598435695
Name:CHARLIES ANGELS HEALTHCARE LLC
Entity Type:Organization
Organization Name:CHARLIES ANGELS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-619-6069
Mailing Address - Street 1:412 BEACH 38TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1514
Mailing Address - Country:US
Mailing Address - Phone:610-619-6069
Mailing Address - Fax:
Practice Address - Street 1:412 BEACH 38TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1514
Practice Address - Country:US
Practice Address - Phone:610-619-6069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care