1134698442 NPI number — VILLAGE OF ANGELS HOME HEALTH CARE LLC

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 1134698442 NPI number — VILLAGE OF ANGELS HOME HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF ANGELS HOME HEALTH CARE LLC
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:
1134698442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
470 JAMES STREET
Provider Second Line Business Mailing Address:
SUITE 007
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-782-6435
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 JAMES STREET
Provider Second Line Business Practice Location Address:
SUITE 007
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-782-6435
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
TITUS
Authorized Official First Name:
JILLIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/CO-OWNER
Authorized Official Telephone Number:
866-782-6435

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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