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General NPI Number Information
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NPI Number | 1437274073
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Entity Type | Organization
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Legal Business Name | ACTIVE ANGELS IN HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 9191 W FLORISSANT AVE SUITE 215
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City | SAINT LOUIS
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State | MO
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Zip | 63136-1424
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Country | US
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Telephone | 314-524-4200
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Fax | 314-524-4203
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Provider Business Mailing Address
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Address Line | 9191 W FLORISSANT AVE SUITE 215
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City | SAINT LOUIS
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State | MO
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Zip | 63136-1424
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Country | US
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Telephone | 314-524-4200
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Fax | 314-524-4203
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Authorized Official
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Title or Position | DIRECTOR(OWNER)
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Name | MS. SHARON LORETTA PETERS
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Credential | STATE CERTIFIED
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Telephone | 314-524-4200
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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 | LCO762551
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License Number State | MO
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