1811227770 NPI number — ANGELS ON HIGH, 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 1811227770 NPI number — ANGELS ON HIGH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELS ON HIGH, 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:
1811227770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 OCEAN STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SOUTH PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-767-5820
Provider Business Mailing Address Fax Number:
207-799-5225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04106-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-767-5820
Provider Business Practice Location Address Fax Number:
207-799-5225
Provider Enumeration Date:
12/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAMILTON
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
207-767-5820

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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