Provider Demographics
NPI:1689921694
Name:VISITING ANGELS SANTA ROSA
Entity Type:Organization
Organization Name:VISITING ANGELS SANTA ROSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CREMIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-528-3801
Mailing Address - Street 1:1120 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4815
Mailing Address - Country:US
Mailing Address - Phone:707-528-3801
Mailing Address - Fax:
Practice Address - Street 1:1120 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4815
Practice Address - Country:US
Practice Address - Phone:707-528-3801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health