Healthcare Provider Details

I. General information

NPI: 1376465708
Provider Name (Legal Business Name): 3&1 ANGELS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CHURCH ST STE 224
FERGUSON MO
63135-2460
US

IV. Provider business mailing address

119 CHURCH ST STE 224
FERGUSON MO
63135-2460
US

V. Phone/Fax

Practice location:
  • Phone: 314-324-8739
  • Fax: 314-224-1660
Mailing address:
  • Phone: 314-324-8739
  • Fax: 314-224-1660

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: OWNER
Credential: LPN
Phone: 314-986-5241