Provider Demographics
NPI:1841691540
Name:HEAVEN'S ANGELS AGENCY
Entity type:Organization
Organization Name:HEAVEN'S ANGELS AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-916-7577
Mailing Address - Street 1:130 HOLLY STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06607-1035
Mailing Address - Country:US
Mailing Address - Phone:203-916-7577
Mailing Address - Fax:203-916-7575
Practice Address - Street 1:130 HOLLY STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06607-1035
Practice Address - Country:US
Practice Address - Phone:203-916-7577
Practice Address - Fax:203-916-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care