Provider Demographics
NPI:1073932679
Name:ANGELIC HOME CARE
Entity Type:Organization
Organization Name:ANGELIC HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LAVERA
Authorized Official - Last Name:CUNNIGAN-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-250-2016
Mailing Address - Street 1:840 E 155TH ST
Mailing Address - Street 2:@ND FLR
Mailing Address - City:PHOENIX
Mailing Address - State:IL
Mailing Address - Zip Code:60426-2552
Mailing Address - Country:US
Mailing Address - Phone:708-250-2016
Mailing Address - Fax:708-339-3682
Practice Address - Street 1:840 E 155TH ST
Practice Address - Street 2:@ND FLR
Practice Address - City:PHOENIX
Practice Address - State:IL
Practice Address - Zip Code:60426-2552
Practice Address - Country:US
Practice Address - Phone:708-250-2016
Practice Address - Fax:708-339-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health