Provider Demographics
NPI:1194213223
Name:ABUNDANT ANGELS LLC
Entity Type:Organization
Organization Name:ABUNDANT ANGELS LLC
Other - Org Name:ABUNDANT ANGELS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMANITA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:JONES-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-494-3079
Mailing Address - Street 1:6 MERRI LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-5233
Mailing Address - Country:US
Mailing Address - Phone:314-494-3079
Mailing Address - Fax:
Practice Address - Street 1:6 MERRI LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5233
Practice Address - Country:US
Practice Address - Phone:314-494-3079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health