Provider Demographics
NPI:1891445789
Name:1ST ANGEL HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:1ST ANGEL HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NASSHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KALASHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-545-8927
Mailing Address - Street 1:8644 GOLF LANE DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3493
Mailing Address - Country:US
Mailing Address - Phone:602-545-8927
Mailing Address - Fax:
Practice Address - Street 1:8344 HALL RD STE 210A
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5554
Practice Address - Country:US
Practice Address - Phone:248-464-4920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health