Organization
MINK ANGEL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA RACHELLE JOHNSON (CEO)
(267) 408-7984
Entity
Organization
Contact information
Practice address
5631 N 16TH ST, PHILADELPHIA, PA 19141-1710
(267) 627-4740
Mailing address
171 W SEYMOUR ST, PHILADELPHIA, PA 19144-3661
(126) 740-8798
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
04/08/2022
Last updated
04/25/2022
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