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General NPI Number Information
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NPI Number | 1629074430
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Entity Type | Organization
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Legal Business Name | ANGELICA, INC.
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 1101 E LOOMIS RD
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City | WEATHERFORD
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State | OK
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Zip | 73096-3318
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Country | US
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Telephone | 580-772-1003
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Fax | 580-772-0298
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Provider Business Mailing Address
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Address Line | PO BOX 401
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City | WEATHERFORD
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State | OK
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Zip | 73096-0401
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Country | US
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Telephone | 580-772-1003
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Fax | 580-772-0298
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANITA J MERIDA
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Credential |
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Telephone | 580-772-1003
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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 | HC7567
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License Number State | OK
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