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General NPI Number Information
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NPI Number | 1134463680
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Entity Type | Organization
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Legal Business Name | THREE ANGEL'S COVENANT CARE 'LLC'
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Dates
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Enumeration Date | 11/23/2012
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Last Update Date | 11/23/2012
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Provider Practice Location Address
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Address Line | 325 W SABINE ST SUITE E5
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City | CARTHAGE
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State | TX
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Zip | 75633-2549
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Country | US
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Telephone | 903-234-0114
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Fax |
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Provider Business Mailing Address
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Address Line | 325 W SABINE ST SUITE E5
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City | CARTHAGE
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State | TX
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Zip | 75633-2549
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Country | US
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Telephone | 903-234-0114
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. EQUALLIA YVONNE MALONE
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Credential |
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Telephone | 903-234-0114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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