Provider Demographics
NPI:1912765959
Name:ANGELS ON CALL HOMECARE AND MEDICAL STAFFING LLC
Entity Type:Organization
Organization Name:ANGELS ON CALL HOMECARE AND MEDICAL STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-839-3309
Mailing Address - Street 1:5215 N IRONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4915
Mailing Address - Country:US
Mailing Address - Phone:414-209-5579
Mailing Address - Fax:
Practice Address - Street 1:5215 N IRONWOOD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4915
Practice Address - Country:US
Practice Address - Phone:414-209-5579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care