Provider Demographics
NPI:1093219263
Name:ANGELS HOME
Entity Type:Organization
Organization Name:ANGELS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-497-1540
Mailing Address - Street 1:1842 OLYMPUS DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-4195
Mailing Address - Country:US
Mailing Address - Phone:214-641-2225
Mailing Address - Fax:
Practice Address - Street 1:2612 CROOKED CRK
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4216
Practice Address - Country:US
Practice Address - Phone:214-497-1540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility