Provider Demographics
NPI:1477764348
Name:ANGELS PRN, INC.
Entity Type:Organization
Organization Name:ANGELS PRN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-726-9163
Mailing Address - Street 1:2755 S 4TH AVE BLDG 1
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7298
Mailing Address - Country:US
Mailing Address - Phone:928-726-9163
Mailing Address - Fax:928-726-1040
Practice Address - Street 1:2755 S 4TH AVE BLDG 1
Practice Address - Street 2:SUITE 101
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7298
Practice Address - Country:US
Practice Address - Phone:928-726-9163
Practice Address - Fax:928-726-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3767251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ920266Medicaid
AZ037269Medicare Oscar/Certification