Provider Demographics
NPI:1407609399
Name:ANGELICAL HANDS WOUND CARE, LLC
Entity Type:Organization
Organization Name:ANGELICAL HANDS WOUND CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GREEN-BARKSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, SWOC
Authorized Official - Phone:313-899-0092
Mailing Address - Street 1:14231 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2894
Mailing Address - Country:US
Mailing Address - Phone:313-899-0092
Mailing Address - Fax:
Practice Address - Street 1:6451 DIVERSEY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-1151
Practice Address - Country:US
Practice Address - Phone:313-899-0092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty