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General NPI Number Information
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NPI Number | 1073651030
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Entity Type | Organization
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Legal Business Name | ANGEL SQUARE INC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 915 & HALF EAST 7TH
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City | CONCORDIA
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State | KS
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Zip | 66901
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Country | US
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Telephone | 785-243-2262
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Fax |
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Provider Business Mailing Address
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Address Line | 915 & HALF EAST 7TH
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City | CONCORDIA
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State | KS
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Zip | 66901
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Country | US
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Telephone | 785-243-2262
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOLENE CARTER
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Credential |
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Telephone | 785-243-2262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | KS
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