Provider Demographics
NPI:1306218219
Name:ANGELES EXPRESS CORP
Entity Type:Organization
Organization Name:ANGELES EXPRESS CORP
Other - Org Name:ANGELES EXPRESS CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANGER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:CHIVATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-886-2599
Mailing Address - Street 1:1210 N PULASKI ROAD APT.3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651
Mailing Address - Country:US
Mailing Address - Phone:773-886-2599
Mailing Address - Fax:
Practice Address - Street 1:1210 N PULASKI RD APT 3
Practice Address - Street 2:1210 N PULASKI APT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-1909
Practice Address - Country:US
Practice Address - Phone:773-886-2599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC13654191952347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle