Provider Demographics
NPI:1457636359
Name:GIFTED ANGELS QUALITY HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:GIFTED ANGELS QUALITY HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CORRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:414-610-3789
Mailing Address - Street 1:PO BOX 342597
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53234-2597
Mailing Address - Country:US
Mailing Address - Phone:262-716-3136
Mailing Address - Fax:
Practice Address - Street 1:3983 S PRAIRIE HILL LN APT 107
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-2368
Practice Address - Country:US
Practice Address - Phone:262-617-3136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health