Healthcare Provider Details

I. General information

NPI: 1063071207
Provider Name (Legal Business Name): ANGEL SKIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 LITTLE TEXAS RD
TRAVELERS REST SC
29690-9525
US

IV. Provider business mailing address

1748 LITTLE TEXAS RD
TRAVELERS REST SC
29690-9525
US

V. Phone/Fax

Practice location:
  • Phone: 575-741-8816
  • Fax:
Mailing address:
  • Phone: 575-741-8816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335U00000X
TaxonomyOrgan Procurement Organization
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3418M1120X
TaxonomyMilitary or U.S. Coast Guard Air Transport Ambulance
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code344800000X
TaxonomyAir Carrier
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State
# 11
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY DAWN MORRIS
Title or Position: OWNER
Credential:
Phone: 575-741-8816