Provider Demographics
NPI:1083889182
Name:ANGELIC HANDS LLC
Entity Type:Organization
Organization Name:ANGELIC HANDS LLC
Other - Org Name:GUARDIAN ANGEL
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-565-7134
Mailing Address - Street 1:925 S BROADWAY
Mailing Address - Street 2:STE. 286
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-4033
Mailing Address - Country:US
Mailing Address - Phone:970-565-7134
Mailing Address - Fax:970-565-9404
Practice Address - Street 1:925 S BROADWAY
Practice Address - Street 2:STE. 286
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-4033
Practice Address - Country:US
Practice Address - Phone:970-565-7134
Practice Address - Fax:970-565-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46924345Medicaid