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General NPI Number Information
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NPI Number | 1598159063
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Entity Type | Organization
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Legal Business Name | SMILING ANGEL HOME CARE SERVICE LLC
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 1413 N 35TH ST UNIT 3
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City | BISMARCK
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State | ND
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Zip | 58501-7714
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Country | US
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Telephone | 701-226-0456
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Fax | 701-751-2753
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Provider Business Mailing Address
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Address Line | 1413 N 35TH ST UNIT 3
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City | BISMARCK
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State | ND
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Zip | 58501-7714
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Country | US
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Telephone | 701-226-0456
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Fax | 701-751-2753
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAXINE MONICA GORDON
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Credential |
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Telephone | 701-226-0456
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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 | 37790100
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License Number State | ND
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