Provider Demographics
NPI:1083065387
Name:ANGELS AT HOME,LLC
Entity Type:Organization
Organization Name:ANGELS AT HOME,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:314-304-5135
Mailing Address - Street 1:2681 SUNNY MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-4600
Mailing Address - Country:US
Mailing Address - Phone:314-304-5135
Mailing Address - Fax:702-543-6749
Practice Address - Street 1:2681 SUNNY MEADOWS RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-4600
Practice Address - Country:US
Practice Address - Phone:314-304-5135
Practice Address - Fax:702-543-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care