Healthcare Provider Details

I. General information

NPI: 1780817668
Provider Name (Legal Business Name): AN ANGELS TOUCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 BRIDGE ST
LAS VEGAS NM
87701-3427
US

IV. Provider business mailing address

146 BRIDGE ST
LAS VEGAS NM
87701-3427
US

V. Phone/Fax

Practice location:
  • Phone: 505-454-1595
  • Fax: 505-454-1510
Mailing address:
  • Phone: 505-454-1595
  • Fax: 505-454-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number03157629000
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number03157629000
License Number StateNM

VIII. Authorized Official

Name: MR. PHILLIP CHARLES WARFIELD
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 505-454-1595