Provider Demographics
NPI:1437274073
Name:ACTIVE ANGELS IN HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:ACTIVE ANGELS IN HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR(OWNER)
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LORETTA
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:STATE CERTIFIED
Authorized Official - Phone:314-524-4200
Mailing Address - Street 1:9191 W FLORISSANT AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-1424
Mailing Address - Country:US
Mailing Address - Phone:314-524-4200
Mailing Address - Fax:314-524-4203
Practice Address - Street 1:9191 W FLORISSANT AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1424
Practice Address - Country:US
Practice Address - Phone:314-524-4200
Practice Address - Fax:314-524-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLCO762551251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0008897OtherSSBG GR