Provider Demographics
NPI:1699171553
Name:ANGELS IN WAITING HEALTHCARE PROVIDERS, LLC
Entity type:Organization
Organization Name:ANGELS IN WAITING HEALTHCARE PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-205-8278
Mailing Address - Street 1:8324 TYLER BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4221
Mailing Address - Country:US
Mailing Address - Phone:440-205-8278
Mailing Address - Fax:440-205-8277
Practice Address - Street 1:8324 TYLER BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4221
Practice Address - Country:US
Practice Address - Phone:440-205-8278
Practice Address - Fax:440-205-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2317558251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health