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NPI Code Detail

MEDICARE: ANGEL UNAWARE

MEDICARE: ANGEL UNAWARE
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
1251G00000XCommunity Based Hospice Care Agency

General Provider Information

NPI Number : 1902294150
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANGEL UNAWARE
Provider Business Mailing Address
First Line : 6417 DRURY LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-4403
Country : US
Telephone Number : 817-505-3867
Fax Number :
Provider Business Practice Location Address
First Line : 6417 DRURY LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-4403
Country : US
Telephone Number : 817-505-3867
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MRS. CONSTANCE DIANNE KOEHLER
Credential : R.N.
Telephone Number : 817-505-3867
Provider Enumeration Date : 12/22/2014
Last Update Date : 12/22/2014

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Directions to “ANGEL UNAWARE ” Practice Location

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