Provider Demographics
NPI:1689668923
Name:COMMUNITY OF HELPING ANGELS, INC.
Entity Type:Organization
Organization Name:COMMUNITY OF HELPING ANGELS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KINGMAN
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-439-1528
Mailing Address - Street 1:10240 N 31ST AVE
Mailing Address - Street 2:SU. 114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9558
Mailing Address - Country:US
Mailing Address - Phone:602-595-5129
Mailing Address - Fax:602-938-3797
Practice Address - Street 1:10240 N 31ST AVE
Practice Address - Street 2:SU. 114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9558
Practice Address - Country:US
Practice Address - Phone:602-595-5129
Practice Address - Fax:602-938-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
AZUNLICENSED376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered251E00000XAgenciesHome Health
Not Answered376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ711699Medicaid