Provider Demographics
NPI:1093910168
Name:ANGELIC SERCIVES, LLC
Entity Type:Organization
Organization Name:ANGELIC SERCIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,ADM.
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MPH
Authorized Official - Phone:225-644-2326
Mailing Address - Street 1:14046 AIRLINE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737
Mailing Address - Country:US
Mailing Address - Phone:225-644-2326
Mailing Address - Fax:225-647-4754
Practice Address - Street 1:14046 AIRLINE HIGHWAY
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-644-2326
Practice Address - Fax:225-647-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9121251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1172308OtherPERSONAL CARE ATTENDANT
LA1126187OtherELDERLY DISABLED ADULTS
LA1145165OtherSUPERVISE INDEP. LIVING