Healthcare Provider Details

I. General information

NPI: 1700706116
Provider Name (Legal Business Name): ANGELA W ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6009 WINDING CREEK BLVD
LIBERTY TWP OH
45011-1335
US

IV. Provider business mailing address

6009 WINDING CREEK BLVD
LIBERTY TWP OH
45011-1335
US

V. Phone/Fax

Practice location:
  • Phone: 317-695-0514
  • Fax:
Mailing address:
  • Phone: 317-695-0514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number0906863
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number0906863
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number0906863
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number0906863
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: