Provider Demographics
NPI:1629893276
Name:MECAS ANGELS
Entity type:Organization
Organization Name:MECAS ANGELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:FAWN
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-422-6941
Mailing Address - Street 1:950 28TH ST SE STE 101E
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-1399
Mailing Address - Country:US
Mailing Address - Phone:616-422-6941
Mailing Address - Fax:
Practice Address - Street 1:950 28TH ST SE STE 101E
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-1399
Practice Address - Country:US
Practice Address - Phone:616-422-6941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health