Provider Demographics
NPI:1770754871
Name:ANGELS HOME DIRECT CARE
Entity type:Organization
Organization Name:ANGELS HOME DIRECT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IGNATIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-585-2272
Mailing Address - Street 1:1905 ARAPAHOE CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:64034-8636
Mailing Address - Country:US
Mailing Address - Phone:816-537-0668
Mailing Address - Fax:
Practice Address - Street 1:1905 ARAPAHOE CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MO
Practice Address - Zip Code:64034-8636
Practice Address - Country:US
Practice Address - Phone:816-537-0668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25OtherAGENCY