- Enrollment id
- O20220902000150
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255064325
- Multiple npi flag
- N
- Ccn
- 148142
- Associate id
- 7517341969
- Organization name
- ANGELS HOME HEALTHCARE SERVICES INC
- Incorporation date
- 2022-04-25
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2250 E DEVON AVE
- Address line 2
- STE 333
- City
- DES PLAINES
- State
- IL
- Zip code
- 600184532