Healthcare Provider Details

I. General information

NPI: 1154272342
Provider Name (Legal Business Name): ANGELIC 316 CARE CONSUMER DIRECTED SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 GREENBROOK DR
JENNINGS MO
63136-3848
US

IV. Provider business mailing address

8800 GREENBROOK DR
JENNINGS MO
63136-3848
US

V. Phone/Fax

Practice location:
  • Phone: 314-409-0601
  • Fax:
Mailing address:
  • Phone: 314-409-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANGELIQUE BRIONNA BROWN
Title or Position: OWNER
Credential:
Phone: 314-409-0601