Provider Demographics
NPI:1902294150
Name:ANGEL UNAWARE
Entity Type:Organization
Organization Name:ANGEL UNAWARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-505-3867
Mailing Address - Street 1:6417 DRURY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-4403
Mailing Address - Country:US
Mailing Address - Phone:817-505-3867
Mailing Address - Fax:
Practice Address - Street 1:6417 DRURY LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-4403
Practice Address - Country:US
Practice Address - Phone:817-505-3867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based