MEDICARE: ANGELS ON DUTY

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		MO

General Provider Information

NPI Number	:	1912276288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS ON DUTY

Provider Business Mailing Address
First Line	:	115 CIVIC PARK DR
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-1664
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 CIVIC PARK DR
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-1664
Country	:	US
Telephone Number	:	636-980-4256
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SHARON VERMILYE
Credential	:
Telephone Number	:	636-980-4256

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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Directions to “ANGELS ON DUTY ” Practice Location

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