1053637231 NPI number — RESCUE ANGELS ADULT CARE

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 1053637231 NPI number — RESCUE ANGELS ADULT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESCUE ANGELS ADULT 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:
Provider Other Organization Name Type Code:
6
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:
1053637231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2808 MOUNT PISGAH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILGORE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75662-8356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-821-7259
Provider Business Mailing Address Fax Number:
903-981-0450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2808 MOUNT PISGAH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILGORE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75662-8356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-821-7259
Provider Business Practice Location Address Fax Number:
903-981-0450
Provider Enumeration Date:
04/14/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
DAVIS
Authorized Official Title or Position:
DIRECTOR/PROGRAM MGR.
Authorized Official Telephone Number:
817-821-7259

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , 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)