Healthcare Provider Details

I. General information

NPI: 1225268311
Provider Name (Legal Business Name): ANGELS ON DUTY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11008 VOSS AVE
KELLER TX
76248-5079
US

IV. Provider business mailing address

PO BOX 2831
KELLER TX
76244-2831
US

V. Phone/Fax

Practice location:
  • Phone: 817-431-5060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number725998
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number725998
License Number StateTX

VIII. Authorized Official

Name: MRS. TYSA Q TAYLOR
Title or Position: PRESIDENT
Credential: RN
Phone: 817-431-5060