Provider Demographics
NPI:1871932640
Name:ANGELIC HANDS, INC
Entity type:Organization
Organization Name:ANGELIC HANDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-565-7134
Mailing Address - Street 1:343 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3772
Mailing Address - Country:US
Mailing Address - Phone:970-565-7134
Mailing Address - Fax:970-565-9404
Practice Address - Street 1:343 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3772
Practice Address - Country:US
Practice Address - Phone:970-565-7134
Practice Address - Fax:970-565-9404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELIC HANDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-14
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2013-HHA-UT000579251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000142692Medicaid