Provider Demographics
NPI:1134463680
Name:THREE ANGEL'S COVENANT CARE 'LLC'
Entity Type:Organization
Organization Name:THREE ANGEL'S COVENANT CARE 'LLC'
Other - Org Name:THREE ANGEL'S COVENANT CARE 'LLC'
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EQUALLIA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-234-0114
Mailing Address - Street 1:325 W SABINE ST
Mailing Address - Street 2:SUITE E5
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-2549
Mailing Address - Country:US
Mailing Address - Phone:903-234-0114
Mailing Address - Fax:
Practice Address - Street 1:325 W SABINE ST
Practice Address - Street 2:SUITE E5
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-2549
Practice Address - Country:US
Practice Address - Phone:903-234-0114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service