Provider Demographics
NPI:1013641174
Name:DOMINIQUE ANGELS HOME CARE LLC
Entity Type:Organization
Organization Name:DOMINIQUE ANGELS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER/HOME HEALTH AIDE
Authorized Official - Prefix:
Authorized Official - First Name:ANTIONETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAVENELL
Authorized Official - Suffix:
Authorized Official - Credentials:HOME HEALTH AIDE
Authorized Official - Phone:817-500-3873
Mailing Address - Street 1:2200 CLOVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-1434
Mailing Address - Country:US
Mailing Address - Phone:817-500-3873
Mailing Address - Fax:817-200-6203
Practice Address - Street 1:2200 CLOVER PARK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-1434
Practice Address - Country:US
Practice Address - Phone:181-750-0387
Practice Address - Fax:817-200-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty