Healthcare Provider Details

I. General information

NPI: 1366372435
Provider Name (Legal Business Name): 3&1 ANGELS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CHURCH ST STE 124
FERGUSON MO
63135-2437
US

IV. Provider business mailing address

119 CHURCH ST STE 124
FERGUSON MO
63135-2437
US

V. Phone/Fax

Practice location:
  • Phone: 314-986-5241
  • Fax: 314-986-5241
Mailing address:
  • Phone: 314-986-5241
  • Fax: 314-986-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: QUITA HENDERSON
Title or Position: CEO
Credential:
Phone: 314-986-5241