Provider Demographics
NPI:1619353893
Name:TWO ANGEL HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:TWO ANGEL HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-249-2642
Mailing Address - Street 1:8616 NEWBY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63147-1921
Mailing Address - Country:US
Mailing Address - Phone:314-249-2642
Mailing Address - Fax:
Practice Address - Street 1:8616 NEWBY ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63147-1921
Practice Address - Country:US
Practice Address - Phone:314-249-2642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care