Provider Demographics
NPI:1518412360
Name:ANGELS IN MISSION
Entity Type:Organization
Organization Name:ANGELS IN MISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STORM
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-639-8718
Mailing Address - Street 1:1043 ROWLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-1166
Mailing Address - Country:US
Mailing Address - Phone:330-639-8718
Mailing Address - Fax:
Practice Address - Street 1:1043 ROWLAND AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-1166
Practice Address - Country:US
Practice Address - Phone:330-639-8718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7610115253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care