Provider Demographics
NPI:1417151655
Name:ANGEL CARRIERS
Entity Type:Organization
Organization Name:ANGEL CARRIERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NED
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-781-0760
Mailing Address - Street 1:5028 FIRNLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2012
Mailing Address - Country:US
Mailing Address - Phone:330-781-0760
Mailing Address - Fax:330-781-0764
Practice Address - Street 1:5028 FIRNLEY AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2012
Practice Address - Country:US
Practice Address - Phone:330-781-0760
Practice Address - Fax:330-781-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHMTB505275343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2730049Medicaid