Provider Demographics
NPI:1477783082
Name:ANGELS OF INDEPENDENCE
Entity Type:Organization
Organization Name:ANGELS OF INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GOETTI
Authorized Official - Suffix:
Authorized Official - Credentials:CNA, HHA
Authorized Official - Phone:507-213-1486
Mailing Address - Street 1:26992 LAKE JEFFERSON RD.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MN
Mailing Address - Zip Code:56017-4448
Mailing Address - Country:US
Mailing Address - Phone:507-550-4108
Mailing Address - Fax:507-550-4108
Practice Address - Street 1:26992 LAKE JEFFERSON ROAD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MN
Practice Address - Zip Code:56017-4440
Practice Address - Country:US
Practice Address - Phone:507-213-1486
Practice Address - Fax:507-550-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty