Provider Demographics
NPI:1871345801
Name:ANGELIC CARE AND WELLNESS HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:ANGELIC CARE AND WELLNESS HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-445-9164
Mailing Address - Street 1:3006 N LINDBERGH BLVD STE 710
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-3242
Mailing Address - Country:US
Mailing Address - Phone:314-445-9164
Mailing Address - Fax:
Practice Address - Street 1:3006 N LINDBERGH BLVD STE 710
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-3242
Practice Address - Country:US
Practice Address - Phone:314-445-9164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health