=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245533843
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELS IN MOTION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2010
-----------------------------------------------------
Last Update Date | 12/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4091 RIVERSIDE DR SUITE 210
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-590-9102
-----------------------------------------------------
Fax | 909-590-9239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4091 RIVERSIDE DR SUITE 210
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-590-9102
-----------------------------------------------------
Fax | 909-590-9239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. DOMINIQUE ALVAREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-590-9102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------