Provider Demographics
NPI:1114224177
Name:MENE ANGEL HOME & HEALTH CARE
Entity Type:Organization
Organization Name:MENE ANGEL HOME & HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-914-6072
Mailing Address - Street 1:815 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-7205
Mailing Address - Country:US
Mailing Address - Phone:815-914-6072
Mailing Address - Fax:
Practice Address - Street 1:815 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-7205
Practice Address - Country:US
Practice Address - Phone:815-914-6072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATRIARCH'S ENTERPRISE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty