Provider Demographics
NPI:1508278441
Name:A.N.G.E.L.S. HOME HEALTH INC.
Entity Type:Organization
Organization Name:A.N.G.E.L.S. HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:KOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-245-3635
Mailing Address - Street 1:307 N MAIN STREET
Mailing Address - Street 2:PO BOX 923
Mailing Address - City:ELKADER
Mailing Address - State:IA
Mailing Address - Zip Code:52043-0923
Mailing Address - Country:US
Mailing Address - Phone:563-245-3635
Mailing Address - Fax:563-245-3634
Practice Address - Street 1:307 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-0923
Practice Address - Country:US
Practice Address - Phone:563-245-3635
Practice Address - Fax:563-245-3634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0700770Medicaid