Healthcare Provider Details

I. General information

NPI: 1225531288
Provider Name (Legal Business Name): KJ ANGEL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 FLOYD BLVD STE B
SIOUX CITY IA
51108-1419
US

IV. Provider business mailing address

3133 FLOYD BLVD STE B
SIOUX CITY IA
51108-1419
US

V. Phone/Fax

Practice location:
  • Phone: 712-899-9575
  • Fax:
Mailing address:
  • Phone: 712-899-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFF HAMMERSTROM
Title or Position: GENERAL MANAGER
Credential:
Phone: 712-899-9575