Provider Demographics
NPI:1124578174
Name:HOLY ANGELS RESIDENTIAL FACILITY
Entity Type:Organization
Organization Name:HOLY ANGELS RESIDENTIAL FACILITY
Other - Org Name:ANGELWORKS PRE-VOCATIONAL TRAINING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:187-978-5003
Mailing Address - Street 1:10450 ELLERBE RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7712
Mailing Address - Country:US
Mailing Address - Phone:318-797-8500
Mailing Address - Fax:318-797-0801
Practice Address - Street 1:10450 ELLERBE RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7712
Practice Address - Country:US
Practice Address - Phone:318-797-8500
Practice Address - Fax:318-797-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA82511251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1619196383Medicaid
LA1073732749Medicaid
LA1164641833Medicaid
LA1346469012Medicaid
LA1861747638Medicaid
LA1225256038Medicaid
LA1316165418Medicaid
LA1437378106Medicaid
LA1528287299Medicaid
LA1497173090Medicaid
LA1578014387Medicaid
LA1639345853Medicaid
LA1992924658Medicaid
LA1184843849Medicaid
LA1770750747Medicaid
LA1982823654Medicaid