Provider Demographics
| NPI: | 1669369070 |
|---|---|
| Name: | JAVINCHIS ANGELS, LLC |
| Entity type: | Organization |
| Organization Name: | JAVINCHIS ANGELS, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | TRACY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | HORN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 970-471-5641 |
| Mailing Address - Street 1: | 1404 SW MARKET ST UNIT 1216 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LEES SUMMIT |
| Mailing Address - State: | MO |
| Mailing Address - Zip Code: | 64063-3100 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 970-471-5641 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 4397 SW BREEZY POINT LN |
| Practice Address - Street 2: | |
| Practice Address - City: | LEES SUMMIT |
| Practice Address - State: | MO |
| Practice Address - Zip Code: | 64082-4772 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 970-471-5641 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2025-06-18 |
| Last Update Date: | 2025-06-18 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | |
| No | 177F00000X | Other Service Providers | Lodging | |
| No | 251B00000X | Agencies | Case Management | |
| No | 251E00000X | Agencies | Home Health | |
| No | 251F00000X | Agencies | Home Infusion | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 251V00000X | Agencies | Voluntary or Charitable | |
| No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
| No | 311Z00000X | Nursing & Custodial Care Facilities | Custodial Care Facility | |
| No | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
