1316030695 NPI number — HEAVEN'S ANGELS HEALTH CARE SERVICES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316030695 NPI number — HEAVEN'S ANGELS HEALTH CARE SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEAVEN'S ANGELS HEALTH CARE SERVICES 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:
1316030695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7366 N LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
LINCOLNWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60712-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-679-7682
Provider Business Mailing Address Fax Number:
847-679-7685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7366 N LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LINCOLNWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60712-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-679-7682
Provider Business Practice Location Address Fax Number:
847-679-7685
Provider Enumeration Date:
10/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAWIS
Authorized Official First Name:
RAPHIDIEN
Authorized Official Middle Name:
LUCENA
Authorized Official Title or Position:
ADMINISTRATOR/PRESIDENT
Authorized Official Telephone Number:
847-679-7682

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1010563 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1010563 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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