Provider Demographics
NPI:1538607874
Name:CHARLIES ANGELS CARE LLC CDS
Entity type:Organization
Organization Name:CHARLIES ANGELS CARE LLC CDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TEQUILA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-437-5744
Mailing Address - Street 1:10220 EDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-5622
Mailing Address - Country:US
Mailing Address - Phone:314-869-4077
Mailing Address - Fax:314-869-4077
Practice Address - Street 1:10220 EDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-5622
Practice Address - Country:US
Practice Address - Phone:314-869-4077
Practice Address - Fax:314-869-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health