Provider Demographics
NPI:1366457707
Name:ANGEL CORPS
Entity Type:Organization
Organization Name:ANGEL CORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-426-4357
Mailing Address - Street 1:528 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2918
Mailing Address - Country:US
Mailing Address - Phone:260-426-4357
Mailing Address - Fax:260-426-0485
Practice Address - Street 1:528 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2918
Practice Address - Country:US
Practice Address - Phone:260-426-4357
Practice Address - Fax:260-426-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200340660Medicaid