Provider Demographics
NPI:1679766935
Name:ANGELS IN DISGUISE OF CENTRAL OHIO
Entity type:Organization
Organization Name:ANGELS IN DISGUISE OF CENTRAL OHIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-363-1500
Mailing Address - Street 1:2 W WINTER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1991
Mailing Address - Country:US
Mailing Address - Phone:740-363-1500
Mailing Address - Fax:614-259-0063
Practice Address - Street 1:2 W WINTER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1991
Practice Address - Country:US
Practice Address - Phone:740-363-1500
Practice Address - Fax:614-259-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health