Healthcare Provider Details

I. General information

NPI: 1477783082
Provider Name (Legal Business Name): ANGELS OF INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26992 LAKE JEFFERSON ROAD
CLEVELAND MN
56017-4440
US

IV. Provider business mailing address

26992 LAKE JEFFERSON RD.
CLEVELAND MN
56017-4448
US

V. Phone/Fax

Practice location:
  • Phone: 507-213-1486
  • Fax: 507-550-4108
Mailing address:
  • Phone: 507-550-4108
  • Fax: 507-550-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY KAY GOETTI
Title or Position: PRESIDENT C.E.O.
Credential: CNA, HHA
Phone: 507-213-1486