Provider Demographics
NPI:1609228261
Name:ANGEL AIDES LLC
Entity Type:Organization
Organization Name:ANGEL AIDES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:LASHAUNDA
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-707-8770
Mailing Address - Street 1:23602 COACH LIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3670
Mailing Address - Country:US
Mailing Address - Phone:313-707-8770
Mailing Address - Fax:
Practice Address - Street 1:23602 COACH LIGHT DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3670
Practice Address - Country:US
Practice Address - Phone:313-707-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health