Provider Demographics
NPI:1003303066
Name:ANGEL HOME CARE LLC
Entity Type:Organization
Organization Name:ANGEL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WONDWOSSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERSHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-592-2520
Mailing Address - Street 1:19550 INTERNATIONAL BLVD STE 309
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5472
Mailing Address - Country:US
Mailing Address - Phone:206-592-2520
Mailing Address - Fax:206-592-2522
Practice Address - Street 1:19550 INTERNATIONAL BLVD STE 309
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-5472
Practice Address - Country:US
Practice Address - Phone:253-234-7921
Practice Address - Fax:206-592-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care