Provider Demographics
NPI:1902138712
Name:MIDWEST CARE ANGELWOOD, LLC
Entity Type:Organization
Organization Name:MIDWEST CARE ANGELWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEGAL ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-743-0924
Mailing Address - Street 1:3200 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3514
Mailing Address - Country:US
Mailing Address - Phone:541-743-0936
Mailing Address - Fax:541-746-5781
Practice Address - Street 1:78 CENTENNIAL LOOP
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7900
Practice Address - Country:US
Practice Address - Phone:541-743-0936
Practice Address - Fax:541-746-5781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility