Provider Demographics
NPI:1003380387
Name:ANGEL HEART ADULT DAYCARE, LLC
Entity Type:Organization
Organization Name:ANGEL HEART ADULT DAYCARE, LLC
Other - Org Name:ANGEL HEART ADULT DAYCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:ALSHAWY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-650-8221
Mailing Address - Street 1:6612 COTTONWOOD GROVE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-1302
Mailing Address - Country:US
Mailing Address - Phone:719-650-8221
Mailing Address - Fax:
Practice Address - Street 1:6612 COTTONWOOD GROVE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80925-1302
Practice Address - Country:US
Practice Address - Phone:719-650-8221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-19
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care