Provider Demographics
NPI:1083891634
Name:MID CITY ANGELS L.L.C.
Entity Type:Organization
Organization Name:MID CITY ANGELS L.L.C.
Other - Org Name:VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-684-1996
Mailing Address - Street 1:1452 HUGHES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7367
Mailing Address - Country:US
Mailing Address - Phone:817-684-1996
Mailing Address - Fax:817-358-9577
Practice Address - Street 1:906 PALOMINO DR
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-3960
Practice Address - Country:US
Practice Address - Phone:817-684-1996
Practice Address - Fax:817-358-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011024251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health