Provider Demographics
NPI:1306439849
Name:EARTH ANGELS HOME CARE LLC
Entity type:Organization
Organization Name:EARTH ANGELS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ST LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-206-3939
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04461-0216
Mailing Address - Country:US
Mailing Address - Phone:859-206-3939
Mailing Address - Fax:
Practice Address - Street 1:6 CROSBY ST APT 8
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-5406
Practice Address - Country:US
Practice Address - Phone:859-206-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care