Provider Demographics
NPI:1811351620
Name:COMPASSION CARE ANGELS
Entity type:Organization
Organization Name:COMPASSION CARE ANGELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED MANAGER
Authorized Official - Phone:314-243-0527
Mailing Address - Street 1:9632 JACOBI AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2938
Mailing Address - Country:US
Mailing Address - Phone:314-243-0527
Mailing Address - Fax:
Practice Address - Street 1:9632 JACOBI AVE APT 4
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-2938
Practice Address - Country:US
Practice Address - Phone:314-243-0527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOV059063006385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care