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General NPI Number Information
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NPI Number | 1053187666
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Entity Type | Organization
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Legal Business Name | HIGH DESERT ANGELS INCORPORPATED
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 15431 ANACAPA RD STE A
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City | VICTORVILLE
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State | CA
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Zip | 92392-2458
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Country | US
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Telephone | 760-596-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 224 WIND HAVEN DR
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-8009
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Country | US
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Telephone | 185-920-2104
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SARA BRIDGEWATER
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Credential |
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Telephone | 859-202-1049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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