Provider Demographics
NPI:1902406085
Name:NODAK ANGELS LLC
Entity Type:Organization
Organization Name:NODAK ANGELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOCKTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-852-2636
Mailing Address - Street 1:7 3RD ST SE STE 101
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3916
Mailing Address - Country:US
Mailing Address - Phone:701-852-2636
Mailing Address - Fax:
Practice Address - Street 1:7 3RD ST SE STE 101
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3916
Practice Address - Country:US
Practice Address - Phone:701-852-2636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health