Provider Demographics
NPI:1912653981
Name:ANGEL BUDDY HOME HEALTH LLC
Entity Type:Organization
Organization Name:ANGEL BUDDY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:JEANEA
Authorized Official - Last Name:ECHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-876-0171
Mailing Address - Street 1:8313 WOODHURST DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63134-1212
Mailing Address - Country:US
Mailing Address - Phone:314-898-5464
Mailing Address - Fax:
Practice Address - Street 1:6978 CHIPPEWA ST STE 7
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3098
Practice Address - Country:US
Practice Address - Phone:314-876-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO01OtherPRIVATE PAY HOME HEALTH SERVICES