Healthcare Provider Details

I. General information

NPI: 1629816533
Provider Name (Legal Business Name): PAIDEN ANGELS HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 4TH ST STE 100
SAINT LOUIS MO
63102-1821
US

IV. Provider business mailing address

100 S 4TH ST STE 100
SAINT LOUIS MO
63102-1821
US

V. Phone/Fax

Practice location:
  • Phone: 314-458-4153
  • Fax:
Mailing address:
  • Phone: 314-458-4153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAMON VAN I
Title or Position: MANAGER
Credential:
Phone: 314-537-5902