Provider Demographics
NPI:1689275083
Name:TEDDY ANGELS,LLC
Entity Type:Organization
Organization Name:TEDDY ANGELS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-287-3253
Mailing Address - Street 1:2575 OLD GLORY RD STE 620
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9636
Mailing Address - Country:US
Mailing Address - Phone:336-486-8294
Mailing Address - Fax:336-842-5922
Practice Address - Street 1:2575 OLD GLORY RD STE 620
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9636
Practice Address - Country:US
Practice Address - Phone:336-486-8294
Practice Address - Fax:336-842-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC5753Medicaid