Healthcare Provider Details

I. General information

NPI: 1063652519
Provider Name (Legal Business Name): ANGELWINGS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 MAIN ST
GRANDVIEW MO
64030-2538
US

IV. Provider business mailing address

1503 MAIN ST
GRANDVIEW MO
64030
US

V. Phone/Fax

Practice location:
  • Phone: 816-394-1868
  • Fax: 877-803-1868
Mailing address:
  • Phone: 816-394-1867
  • Fax: 877-803-1869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberLCO944539
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberLC0944539
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberLC0944539
License Number StateMO

VIII. Authorized Official

Name: NANCY SHERMAN
Title or Position: OWNER
Credential:
Phone: 816-394-1868