1124461470 NPI number — ANGELS WE CARE

Table of content: SHELLY L OOSTINDIE MS (NPI 1124200423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124461470 NPI number — ANGELS WE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELS WE CARE
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:
ANGELS
Provider Other Organization Name Type Code:
3
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:
1124461470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 LEDGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06905-3319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-918-2748
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 LEDGE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06905-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-918-2748
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DECOSSARD
Authorized Official First Name:
WILFRID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
203-918-2748

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  HCA.0000751 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 153718 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com