Provider Demographics
NPI:1407615735
Name:ACTIVE ANGEL'S HOME CARE
Entity Type:Organization
Organization Name:ACTIVE ANGEL'S HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-759-9496
Mailing Address - Street 1:120 N MICHIGAN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4236
Mailing Address - Country:US
Mailing Address - Phone:989-759-9496
Mailing Address - Fax:989-759-9498
Practice Address - Street 1:120 N MICHIGAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4236
Practice Address - Country:US
Practice Address - Phone:989-759-9496
Practice Address - Fax:989-759-9498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health