Organization
ANGIE'S SPA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGELA MOUGEY (OWNER)
(419) 547-6458
Entity
Organization
Contact information
Practice address
715 S TAFT AVE, FREMONT, OH 43420-3200
(419) 333-2710
(419) 333-2710
Mailing address
26700 BROOKPARK ROAD EXT, SUITE 1, NORTH OLMSTED, OH 44070-3124
(440) 716-1283
(440) 716-1605
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
COSS021129
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2471463
—
OH
Enumeration date
09/25/2006
Last updated
08/22/2020
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