=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982996930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3 ANGELS CAREGIVERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2011
-----------------------------------------------------
Last Update Date | 05/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9754 AMBERLEY DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-575-3585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9754 AMBERLEY DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-575-3585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN
-----------------------------------------------------
Name | NATIVIDAD CHIPANA
-----------------------------------------------------
Credential | LVN
-----------------------------------------------------
Telephone | 214-575-3585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 128009
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------