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General NPI Number Information
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NPI Number | 1629178082
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Entity Type | Organization
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Legal Business Name | ANGIE'S SPA, LLC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 715 S TAFT AVE
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City | FREMONT
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State | OH
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Zip | 43420-3200
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Country | US
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Telephone | 419-333-2710
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Fax | 419-333-2710
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Provider Business Mailing Address
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Address Line | 26700 BROOKPARK ROAD EXT SUITE 1
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3124
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Country | US
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Telephone | 440-716-1283
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Fax | 440-716-1605
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANGELA MOUGEY
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Credential |
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Telephone | 419-547-6458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | COSS021129
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License Number State | OH
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