Provider Demographics
NPI:1942656194
Name:ANGEL OF MINE HOME CARE LLC
Entity Type:Organization
Organization Name:ANGEL OF MINE HOME CARE LLC
Other - Org Name:ANGEL OF MINE HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDEE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:517-358-4668
Mailing Address - Street 1:PO BOX 4052
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-4052
Mailing Address - Country:US
Mailing Address - Phone:517-358-4668
Mailing Address - Fax:
Practice Address - Street 1:223 ROCKWELL ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3154
Practice Address - Country:US
Practice Address - Phone:517-358-4668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care