1376556951 NPI number — ABSOLUTELY ANGELS, INC

Table of content: (NPI 1376556951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376556951 NPI number — ABSOLUTELY ANGELS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUTELY ANGELS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376556951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 S HIGHWAY 377 STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PILOT POINT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76258-4469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-686-0324
Provider Business Mailing Address Fax Number:
940-686-0809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 S HIGHWAY 377 STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PILOT POINT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76258-4469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-686-0324
Provider Business Practice Location Address Fax Number:
940-686-0809
Provider Enumeration Date:
08/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAI
Authorized Official First Name:
SUNIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CFO
Authorized Official Telephone Number:
940-686-0324

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  009536 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 173636501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".