Provider Demographics
NPI:1083859938
Name:ANGELS ON EARTH HOME CARE, LLC.
Entity Type:Organization
Organization Name:ANGELS ON EARTH HOME CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ASCHENBRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-763-4666
Mailing Address - Street 1:420 HASKELL ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1406
Mailing Address - Country:US
Mailing Address - Phone:920-763-4666
Mailing Address - Fax:
Practice Address - Street 1:420 HASKELL ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-1406
Practice Address - Country:US
Practice Address - Phone:920-763-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care