Provider Demographics
NPI:1083828776
Name:ANGEL LOVIN' CARE
Entity Type:Organization
Organization Name:ANGEL LOVIN' CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:DESSELLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-445-3141
Mailing Address - Street 1:2131 WETTERMARK ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3753
Mailing Address - Country:US
Mailing Address - Phone:318-445-3141
Mailing Address - Fax:318-445-3149
Practice Address - Street 1:2131 WETTERMARK ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3753
Practice Address - Country:US
Practice Address - Phone:318-445-3141
Practice Address - Fax:318-445-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA311ZA0620X311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1148521Medicaid