Provider Demographics
NPI:1043692270
Name:ANGELIC HEALTHCARE SERVICES , INC.
Entity Type:Organization
Organization Name:ANGELIC HEALTHCARE SERVICES , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BERNADETTE
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-307-9406
Mailing Address - Street 1:637 GEORGES RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3331
Mailing Address - Country:US
Mailing Address - Phone:908-307-3406
Mailing Address - Fax:718-447-5178
Practice Address - Street 1:637 GEORGES RD
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3331
Practice Address - Country:US
Practice Address - Phone:908-307-3406
Practice Address - Fax:718-447-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25M08523700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF27840Medicare UPIN