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General NPI Number Information
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NPI Number | 1720103526
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Entity Type | Organization
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Legal Business Name | ANGELO HEALTHCARE SERVICES, INC.
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 5028-A KNICKERBOCKER ROAD
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City | SAN ANGELO
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State | TX
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Zip | 76904
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Country | US
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Telephone | 325-653-4047
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Fax | 325-653-4449
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Provider Business Mailing Address
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Address Line | PO BOX 61146
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City | SAN ANGELO
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State | TX
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Zip | 76906-1146
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Country | US
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Telephone | 325-653-4047
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Fax | 325-653-4449
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROBERTA DIANE ROSS
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Credential | RN
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Telephone | 325-653-4047
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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 | 010644
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License Number State | TX
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