Provider Demographics
NPI:1215202577
Name:WILMA IN-HOME ANGELS INC
Entity Type:Organization
Organization Name:WILMA IN-HOME ANGELS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:FELICIA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:08/26/1971
Authorized Official - Phone:314-775-3639
Mailing Address - Street 1:625 N EUCLID AVE
Mailing Address - Street 2:533
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1690
Mailing Address - Country:US
Mailing Address - Phone:314-361-8083
Mailing Address - Fax:314-361-8087
Practice Address - Street 1:625 N EUCLID AVE
Practice Address - Street 2:533
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1690
Practice Address - Country:US
Practice Address - Phone:314-361-8083
Practice Address - Fax:314-361-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health