1518001379 NPI number — ANGEL'S CARE INC

Table of content: (NPI 1518001379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518001379 NPI number — ANGEL'S CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGEL'S CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518001379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 N OAKS PLZ
Provider Second Line Business Mailing Address:
SUITE 245
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63121-2917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-381-0321
Provider Business Mailing Address Fax Number:
314-381-9509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1734 E 63RD ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64110-3543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-381-0321
Provider Business Practice Location Address Fax Number:
314-381-9509
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREGORY
Authorized Official First Name:
TAWANDA
Authorized Official Middle Name:
ALT
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
314-381-0321

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 268669900 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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