Provider Demographics
NPI:1255096921
Name:WALKING ANGELS NON-MEDICAL HOME CARE AGENCY, LLC
Entity type:Organization
Organization Name:WALKING ANGELS NON-MEDICAL HOME CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-698-4817
Mailing Address - Street 1:948 STONE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-2648
Mailing Address - Country:US
Mailing Address - Phone:618-698-4817
Mailing Address - Fax:
Practice Address - Street 1:948 STONE CREEK LN
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-2648
Practice Address - Country:US
Practice Address - Phone:618-698-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-07
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care