Provider Demographics
NPI:1114484854
Name:ANGELS OF ST. CLAIR, INC.
Entity Type:Organization
Organization Name:ANGELS OF ST. CLAIR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-726-6999
Mailing Address - Street 1:1530 PINE GROVE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3370
Mailing Address - Country:US
Mailing Address - Phone:810-966-2273
Mailing Address - Fax:
Practice Address - Street 1:1530 PINE GROVE AVE STE 7
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3370
Practice Address - Country:US
Practice Address - Phone:810-966-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care