Healthcare Provider Details

I. General information

NPI: 1457797466
Provider Name (Legal Business Name): ATTENDING ANGELS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HIGHWAY AB
SAINT CLAIR MO
63077-3002
US

IV. Provider business mailing address

130 HIGHWAY AB
SAINT CLAIR MO
63077-3002
US

V. Phone/Fax

Practice location:
  • Phone: 314-458-9041
  • Fax: 636-629-8088
Mailing address:
  • Phone: 143-458-9041
  • Fax: 636-629-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE MAHONEY
Title or Position: MANAGER
Credential:
Phone: 314-504-1952