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General NPI Number Information
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NPI Number | 1811351620
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Entity Type | Organization
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Legal Business Name | COMPASSION CARE ANGELS
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 9632 JACOBI AVE APT 4
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City | SAINT LOUIS
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State | MO
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Zip | 63136-2938
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Country | US
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Telephone | 314-243-0527
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Fax |
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Provider Business Mailing Address
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Address Line | 9632 JACOBI AVE APT 4
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City | SAINT LOUIS
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State | MO
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Zip | 63136-2938
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Country | US
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Telephone | 314-243-0527
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Fax |
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Authorized Official
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Title or Position | CERTIFIED MANAGER
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Name | EDNA R BROOKS
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Credential | CERTIFIED MANAGER
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Telephone | 314-243-0527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | V059063006
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License Number State | MO
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