Healthcare Provider Details

I. General information

NPI: 1306491683
Provider Name (Legal Business Name): ANGELA R CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FREEDOM DR
NAPOLEON OH
43545-9021
US

IV. Provider business mailing address

885 COMMERCE DR
PERRYSBURG OH
43551-5267
US

V. Phone/Fax

Practice location:
  • Phone: 800-468-4357
  • Fax:
Mailing address:
  • Phone: 419-330-5119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: