Provider Demographics
NPI:1598159063
Name:SMILING ANGEL HOME CARE SERVICE LLC
Entity type:Organization
Organization Name:SMILING ANGEL HOME CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-226-0456
Mailing Address - Street 1:1413 N 35TH ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-7714
Mailing Address - Country:US
Mailing Address - Phone:701-226-0456
Mailing Address - Fax:701-751-2753
Practice Address - Street 1:1413 N 35TH ST UNIT 3
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-7714
Practice Address - Country:US
Practice Address - Phone:701-226-0456
Practice Address - Fax:701-751-2753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND37790100251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health