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General NPI Number Information
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NPI Number | 1457636359
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Entity Type | Organization
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Legal Business Name | GIFTED ANGELS QUALITY HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 3983 S PRAIRIE HILL LN APT 107
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City | GREENFIELD
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State | WI
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Zip | 53228-2368
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Country | US
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Telephone | 262-617-3136
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 342597
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City | MILWAUKEE
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State | WI
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Zip | 53234-2597
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Country | US
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Telephone | 262-716-3136
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. CORRIE ANN LOPEZ
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Credential | C.N.A
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Telephone | 414-610-3789
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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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