Provider Demographics
NPI:1649309568
Name:ANGELS OF GRACE HME AND SUPPLIES
Entity type:Organization
Organization Name:ANGELS OF GRACE HME AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-413-1578
Mailing Address - Street 1:3500 S BOULEVARD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5486
Mailing Address - Country:US
Mailing Address - Phone:405-340-5100
Mailing Address - Fax:405-340-5109
Practice Address - Street 1:4801 N CLASSEN BLVD
Practice Address - Street 2:STE 237
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4627
Practice Address - Country:US
Practice Address - Phone:405-858-8401
Practice Address - Fax:405-858-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies