Provider Demographics
NPI:1295227858
Name:ANGELA & DEANDRE MOVEMENT
Entity Type:Organization
Organization Name:ANGELA & DEANDRE MOVEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:MS
Authorized Official - First Name:RODKEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-889-9976
Mailing Address - Street 1:13702 CARSA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2729
Mailing Address - Country:US
Mailing Address - Phone:832-889-9976
Mailing Address - Fax:
Practice Address - Street 1:13702 CARSA LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2729
Practice Address - Country:US
Practice Address - Phone:832-889-9976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X, 253Z00000X, 332U00000X, 335G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No332U00000XSuppliersHome Delivered Meals
No335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid