Provider Demographics
NPI:1003210295
Name:PROFESSIONAL ANGEL CARE, LTD.
Entity Type:Organization
Organization Name:PROFESSIONAL ANGEL CARE, LTD.
Other - Org Name:IN-HOME PROFESSIONAL CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANOLITO
Authorized Official - Middle Name:DEL ROSARIO
Authorized Official - Last Name:GAWAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-907-8991
Mailing Address - Street 1:3525 W. PETERSON AVENUE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3314
Mailing Address - Country:US
Mailing Address - Phone:773-907-8991
Mailing Address - Fax:773-907-8992
Practice Address - Street 1:3525 W. PETERSON AVENUE
Practice Address - Street 2:SUITE 222
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3314
Practice Address - Country:US
Practice Address - Phone:773-907-8991
Practice Address - Fax:773-907-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000440253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care