Provider Demographics
NPI:1003818220
Name:ANGELA HOSPICE HOME CARE, INC.
Entity Type:Organization
Organization Name:ANGELA HOSPICE HOME CARE, INC.
Other - Org Name:ANGELA HOSPICE CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SISTER MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOVANNI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSA
Authorized Official - Phone:734-953-6046
Mailing Address - Street 1:14100 NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5010
Mailing Address - Country:US
Mailing Address - Phone:734-464-7810
Mailing Address - Fax:734-779-4601
Practice Address - Street 1:14100 NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5010
Practice Address - Country:US
Practice Address - Phone:734-464-7810
Practice Address - Fax:734-779-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI823514251G00000X
MI824025315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2587662Medicaid
MI08717OtherBCBS OF MICHIGAN
MIOP22020OtherMEDICARE PART B
MIOP22020OtherMEDICARE PART B