Provider Demographics
NPI:1053603415
Name:AUDREYS ANGELS IN HOME CARE LLC
Entity type:Organization
Organization Name:AUDREYS ANGELS IN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PAMELA
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-447-1315
Mailing Address - Street 1:4125 MILLERS RDG
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7765
Mailing Address - Country:US
Mailing Address - Phone:636-447-1315
Mailing Address - Fax:
Practice Address - Street 1:4125 MILLERS RDG
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-7765
Practice Address - Country:US
Practice Address - Phone:636-447-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUDREYS ANGELS IN HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care