1871932640 NPI number — ANGELIC HANDS, INC

Table of content: (NPI 1871932640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871932640 NPI number — ANGELIC HANDS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELIC HANDS, 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:
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:
1871932640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
343 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORTEZ
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81321-3772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-565-7134
Provider Business Mailing Address Fax Number:
970-565-9404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
343 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTEZ
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81321-3772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-565-7134
Provider Business Practice Location Address Fax Number:
970-565-9404
Provider Enumeration Date:
06/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
O'HARA
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
CHRISTINE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
970-565-7134

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2013-HHA-UT000579 , registered in the state of UT ; 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)

  • Identifier: 9000142692 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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