Provider Demographics
NPI:1730934175
Name:KEVA ANGELS HOME CARE LLC
Entity type:Organization
Organization Name:KEVA ANGELS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CAREGIVER
Authorized Official - Prefix:
Authorized Official - First Name:REKEEVA
Authorized Official - Middle Name:YAVETTE
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-341-3344
Mailing Address - Street 1:3310 COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1859
Mailing Address - Country:US
Mailing Address - Phone:810-341-3344
Mailing Address - Fax:
Practice Address - Street 1:3432 DAVISON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-3935
Practice Address - Country:US
Practice Address - Phone:810-341-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9674923Medicaid