Provider Demographics
NPI:1013602903
Name:AWESOME ANGELS HOMECARE LLC
Entity Type:Organization
Organization Name:AWESOME ANGELS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEDDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-829-7743
Mailing Address - Street 1:8895 TRILLIUM DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9499
Mailing Address - Country:US
Mailing Address - Phone:734-829-7743
Mailing Address - Fax:734-661-6206
Practice Address - Street 1:8895 TRILLIUM DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9499
Practice Address - Country:US
Practice Address - Phone:734-829-7743
Practice Address - Fax:734-661-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI87-474386Medicaid