Healthcare Provider Details

I. General information

NPI: 1154755338
Provider Name (Legal Business Name): ANGELS WITHIN CDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2013
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 W FLORISSANT AVE
SAINT LOUIS MO
63115-3056
US

IV. Provider business mailing address

2536 PERSHALL RD
SAINT LOUIS MO
63136-4527
US

V. Phone/Fax

Practice location:
  • Phone: 314-280-5557
  • Fax: 314-869-5954
Mailing address:
  • Phone: 314-280-5557
  • Fax: 314-869-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number305R00000X
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number305R00000X
License Number StateMO

VIII. Authorized Official

Name: MS. KAREN GREER
Title or Position: MANAGER
Credential:
Phone: 314-280-5557