Healthcare Provider Details

I. General information

NPI: 1548505225
Provider Name (Legal Business Name): ANNIE'S ANGLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E BUTLER RD SUITE C
MAULDIN SC
29662-3249
US

IV. Provider business mailing address

408 E BUTLER RD SUITE C
MAULDIN SC
29662-3249
US

V. Phone/Fax

Practice location:
  • Phone: 864-335-8224
  • Fax:
Mailing address:
  • Phone: 864-335-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBBIN HAIRSTON
Title or Position: OWNER
Credential:
Phone: 614-446-8871