Provider Demographics
NPI:1710628656
Name:JOANNA TEDFORD
Entity Type:Organization
Organization Name:JOANNA TEDFORD
Other - Org Name:ANGELS HOMECARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-761-5288
Mailing Address - Street 1:4174 STARLIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4174 STARLIGHT AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1290
Practice Address - Country:US
Practice Address - Phone:217-761-5288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center