Provider Demographics
NPI:1932670155
Name:ANGELA'S AWESOME ANGELS LLC
Entity Type:Organization
Organization Name:ANGELA'S AWESOME ANGELS LLC
Other - Org Name:AAA HOME AND HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-243-0527
Mailing Address - Street 1:1360 S 5TH ST STE 280
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2446
Mailing Address - Country:US
Mailing Address - Phone:636-410-8220
Mailing Address - Fax:
Practice Address - Street 1:AAA HOME AND HEALTH CARE SERVICES,1360 S 5TH ST STE 280
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2446
Practice Address - Country:US
Practice Address - Phone:636-410-8220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO487080978Medicaid