Provider Demographics
NPI:1538435839
Name:ANDREA'S ANGELS, INC.
Entity type:Organization
Organization Name:ANDREA'S ANGELS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-300-7321
Mailing Address - Street 1:3109 35TH AVE
Mailing Address - Street 2:A-101
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9475
Mailing Address - Country:US
Mailing Address - Phone:970-352-4124
Mailing Address - Fax:970-352-8446
Practice Address - Street 1:3109 35TH AVE
Practice Address - Street 2:A-101
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9475
Practice Address - Country:US
Practice Address - Phone:970-352-4124
Practice Address - Fax:970-352-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10R133251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80050379Medicaid