Provider Demographics
NPI:1093846495
Name:MIDLAND EMPIRE RESOURCES FOR INDEPENDENT LIVING INC
Entity Type:Organization
Organization Name:MIDLAND EMPIRE RESOURCES FOR INDEPENDENT LIVING INC
Other - Org Name:ANGELS IN HOME LLC DBA ANGELS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JC
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-279-8558
Mailing Address - Street 1:4420 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-2157
Mailing Address - Country:US
Mailing Address - Phone:816-364-0900
Mailing Address - Fax:816-364-0588
Practice Address - Street 1:1506 S RIVERSIDE RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2578
Practice Address - Country:US
Practice Address - Phone:816-364-0900
Practice Address - Fax:816-364-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO867-HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267614Medicare PIN