=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790081081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABBAS ANGELS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2011
-----------------------------------------------------
Last Update Date | 02/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 621 W OAKDALE DR SUITE A
-----------------------------------------------------
City | FORT WAYNE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46807-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-466-3227
-----------------------------------------------------
Fax | 260-744-6090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 621 W OAKDALE DR SUITE A
-----------------------------------------------------
City | FORT WAYNE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46807-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-466-3227
-----------------------------------------------------
Fax | 260-744-6090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. JEFFRIE ALAN POPPLEWELL
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 260-466-3227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 10-012462-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------