Provider Demographics
NPI:1083951875
Name:ANGELS OF HANDS ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:ANGELS OF HANDS ASSISTED LIVING FACILITY
Other - Org Name:ANGELS OF HANDS HOME HEALTH AGENCY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:972-217-9297
Mailing Address - Street 1:2401 N. HOUSTON SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134
Mailing Address - Country:US
Mailing Address - Phone:972-572-1873
Mailing Address - Fax:972-572-1890
Practice Address - Street 1:6969 PASTOR BAILEY DR
Practice Address - Street 2:STE 150
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2636
Practice Address - Country:US
Practice Address - Phone:972-572-1873
Practice Address - Fax:972-572-1890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELS OF HANDS HOME HEALTH AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103109251J00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid