Provider Demographics
NPI:1093251035
Name:ANGEL CARE FAMILY CLINIC, LLC
Entity Type:Organization
Organization Name:ANGEL CARE FAMILY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUREE
Authorized Official - Middle Name:HOPITAKKUL
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,FNP
Authorized Official - Phone:832-390-4579
Mailing Address - Street 1:8722 SAILING DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2792
Mailing Address - Country:US
Mailing Address - Phone:832-390-4579
Mailing Address - Fax:
Practice Address - Street 1:5330 FM 1960 RD E
Practice Address - Street 2:STE C
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2502
Practice Address - Country:US
Practice Address - Phone:832-390-4579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-14
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP130655OtherAPRN