Provider Demographics
NPI:1245784586
Name:HEAVENLY ANGELS HOME HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:HEAVENLY ANGELS HOME HEALTHCARE SERVICES, LLC
Other - Org Name:HEAVENLY ANGELS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:314-922-7026
Mailing Address - Street 1:100 RUE SAINT FRANCOIS ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-5134
Mailing Address - Country:US
Mailing Address - Phone:314-922-7026
Mailing Address - Fax:
Practice Address - Street 1:100 RUE SAINT FRANCOIS ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5134
Practice Address - Country:US
Practice Address - Phone:314-922-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health