Healthcare Provider Details

I. General information

NPI: 1699595629
Provider Name (Legal Business Name): ELYON ANGELIC CARE AND STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 64TH ST
WEST DES MOINES IA
50266-8632
US

IV. Provider business mailing address

169 64TH ST
WEST DES MOINES IA
50266-8632
US

V. Phone/Fax

Practice location:
  • Phone: 515-525-9157
  • Fax:
Mailing address:
  • Phone: 515-525-9157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELYON RAAH
Title or Position: CEO
Credential:
Phone: 515-525-9157