Healthcare Provider Details

I. General information

NPI: 1801220033
Provider Name (Legal Business Name): HEARTS OF ANGELS AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16360 BROADWAY AVE
MAPLE HEIGHTS OH
44137-2555
US

IV. Provider business mailing address

16360 BROADWAY AVE
MAPLE HEIGHTS OH
44137-2555
US

V. Phone/Fax

Practice location:
  • Phone: 216-952-4838
  • Fax:
Mailing address:
  • Phone: 216-952-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. SAMIRA A ROGERS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 216-952-4838