Healthcare Provider Details

I. General information

NPI: 1255505079
Provider Name (Legal Business Name): ANGLE HANDS SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13797 GOLDENEYE WAY
ROGERS MN
55374-4901
US

IV. Provider business mailing address

13797 GOLDENEYE WAY
ROGERS MN
55374-4901
US

V. Phone/Fax

Practice location:
  • Phone: 763-439-8119
  • Fax: 763-657-1267
Mailing address:
  • Phone: 763-439-8119
  • Fax: 763-657-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateMN

VIII. Authorized Official

Name: MISS ESTELLA KARIN GARDER
Title or Position: OWNER
Credential: OTHER
Phone: 763-439-8119