Healthcare Provider Details

I. General information

NPI: 1518702927
Provider Name (Legal Business Name): ANGELA BAISDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 STRATFORD PL
SPRINGFIELD OH
45504-1410
US

IV. Provider business mailing address

1823 STRATFORD PL
SPRINGFIELD OH
45504-1410
US

V. Phone/Fax

Practice location:
  • Phone: 937-450-0050
  • Fax:
Mailing address:
  • Phone: 937-450-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: