Provider Demographics
NPI:1033593256
Name:ANGEL SENIOR HOME CARE LLC
Entity Type:Organization
Organization Name:ANGEL SENIOR HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:GUYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-925-2900
Mailing Address - Street 1:14100 SULLYFIELD CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1651
Mailing Address - Country:US
Mailing Address - Phone:703-971-4402
Mailing Address - Fax:703-971-3931
Practice Address - Street 1:14100 SULLYFIELD CIR STE 300
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1651
Practice Address - Country:US
Practice Address - Phone:571-216-4727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1531065251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0172457084Medicaid
VA0173199651Medicaid
1033593256OtherNPPS
1033593256OtherNPPS