MEDICARE: ANGELS DIRECT IN HOME HEALTH CARE CDS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	B00488329	MO

General Provider Information

NPI Number	:	1841538568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS DIRECT IN HOME HEALTH CARE CDS LLC

Provider Business Mailing Address
First Line	:	4009 7 HILLS DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6737
Country	:	US
Telephone Number	:	314-598-7164
Fax Number	:	314-289-9456

Provider Business Practice Location Address
First Line	:	4009 7 HILLS DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6737
Country	:	US
Telephone Number	:	314-598-7164
Fax Number	:	314-289-9456

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ARIANNA LASHON ROBERTS
Credential	:
Telephone Number	:	314-598-7164

Provider Enumeration Date	:	01/31/2013
Last Update Date	:	01/31/2013

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