Healthcare Provider Details

I. General information

NPI: 1912030107
Provider Name (Legal Business Name): ANGELS ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14533 JEFFERSON ST
HARVEY IL
60426-1813
US

IV. Provider business mailing address

PO BOX 277998
RIVERDALE IL
60827-7998
US

V. Phone/Fax

Practice location:
  • Phone: 708-548-8474
  • Fax: 815-572-5803
Mailing address:
  • Phone: 708-548-8474
  • Fax: 815-572-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SHATAUNDRIA COTTON
Title or Position: OWNER
Credential:
Phone: 708-548-8474