Provider Demographics
NPI:1073739975
Name:ANGEL CARE HOSPICE, INC.
Entity Type:Organization
Organization Name:ANGEL CARE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-534-8242
Mailing Address - Street 1:1406 NE EVANGELINE TRWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2830
Mailing Address - Country:US
Mailing Address - Phone:337-534-8242
Mailing Address - Fax:337-534-8243
Practice Address - Street 1:1406 NE EVANGELINE TRWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2830
Practice Address - Country:US
Practice Address - Phone:337-534-8242
Practice Address - Fax:337-534-8243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA75251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1580449Medicaid
LA191551Medicare Oscar/Certification