Provider Demographics
NPI:1720603707
Name:PRECIOUS ANGELS HOMECARE LLC
Entity Type:Organization
Organization Name:PRECIOUS ANGELS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER 1
Authorized Official - Prefix:MS
Authorized Official - First Name:SHATORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-634-9224
Mailing Address - Street 1:528 EDGEFIELD RD STE H1
Mailing Address - Street 2:
Mailing Address - City:BELVEDERE
Mailing Address - State:SC
Mailing Address - Zip Code:29841-1922
Mailing Address - Country:US
Mailing Address - Phone:803-634-9224
Mailing Address - Fax:
Practice Address - Street 1:528 EDGEFIELD RD STE H1
Practice Address - Street 2:
Practice Address - City:BELVEDERE
Practice Address - State:SC
Practice Address - Zip Code:29841-1922
Practice Address - Country:US
Practice Address - Phone:803-634-9224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care