Provider Demographics
NPI:1285977249
Name:ANGELS OF LOVE LLC
Entity type:Organization
Organization Name:ANGELS OF LOVE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-796-8004
Mailing Address - Street 1:21931 GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2683
Mailing Address - Country:US
Mailing Address - Phone:248-796-8004
Mailing Address - Fax:248-808-6052
Practice Address - Street 1:21931 GARDNER ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2683
Practice Address - Country:US
Practice Address - Phone:248-796-8004
Practice Address - Fax:248-808-6052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health