Provider Demographics
NPI:1821245358
Name:MY3ANGELS LLC.
Entity Type:Organization
Organization Name:MY3ANGELS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-650-2104
Mailing Address - Street 1:54134 OVERBROOK CT.
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWSP
Mailing Address - State:MI
Mailing Address - Zip Code:48316
Mailing Address - Country:US
Mailing Address - Phone:248-650-2104
Mailing Address - Fax:
Practice Address - Street 1:54134 OVERBROOK CT.
Practice Address - Street 2:
Practice Address - City:SHELBY TWSP
Practice Address - State:MI
Practice Address - Zip Code:48316
Practice Address - Country:US
Practice Address - Phone:248-650-2104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization