Healthcare Provider Details

I. General information

NPI: 1003380387
Provider Name (Legal Business Name): ANGEL HEART ADULT DAYCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2019
Last Update Date: 02/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 COTTONWOOD GROVE DR
COLORADO SPRINGS CO
80925-1302
US

IV. Provider business mailing address

6612 COTTONWOOD GROVE DR
COLORADO SPRINGS CO
80925-1302
US

V. Phone/Fax

Practice location:
  • Phone: 719-650-8221
  • Fax:
Mailing address:
  • Phone: 719-650-8221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRITTANY NICHOLE ALSHAWY
Title or Position: OWNER/ADMIN
Credential:
Phone: 719-650-8221