Healthcare Provider Details

I. General information

NPI: 1316223787
Provider Name (Legal Business Name): ANGEL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 87TH TRL N
BROOKLYN PARK MN
55443-3742
US

IV. Provider business mailing address

2609 87TH TRL N
BROOKLYN PARK MN
55443-3742
US

V. Phone/Fax

Practice location:
  • Phone: 763-412-9921
  • Fax:
Mailing address:
  • Phone: 763-412-9921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number355310
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number355310
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number355310
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number355310
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number355310
License Number StateMN
# 9
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number355310
License Number StateMN

VIII. Authorized Official

Name: PHILIP ONYEABOR UWAGWU
Title or Position: DIRECTOR
Credential: RN
Phone: 763-412-9921