Provider Demographics
NPI:1457797466
Name:ATTENDING ANGELS HOME CARE
Entity Type:Organization
Organization Name:ATTENDING ANGELS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-504-1952
Mailing Address - Street 1:130 HIGHWAY AB
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MO
Mailing Address - Zip Code:63077-3002
Mailing Address - Country:US
Mailing Address - Phone:143-458-9041
Mailing Address - Fax:636-629-8088
Practice Address - Street 1:130 HIGHWAY AB
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077-3002
Practice Address - Country:US
Practice Address - Phone:314-458-9041
Practice Address - Fax:636-629-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000011794Medicaid