Provider Demographics
NPI:1851505846
Name:ANGEL'S CARE INC
Entity Type:Organization
Organization Name:ANGEL'S CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAWANDA
Authorized Official - Middle Name:ALT
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-381-0321
Mailing Address - Street 1:23 N. OAKS PLAZA
Mailing Address - Street 2:SUITE 245
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121
Mailing Address - Country:US
Mailing Address - Phone:314-381-0321
Mailing Address - Fax:314-381-9509
Practice Address - Street 1:1734 E. 63RD STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110
Practice Address - Country:US
Practice Address - Phone:314-381-0321
Practice Address - Fax:314-381-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO288669906Medicaid