Provider Demographics
NPI:1144409160
Name:ANGEL BRIGHT HOME HEALTH INC
Entity Type:Organization
Organization Name:ANGEL BRIGHT HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-986-1102
Mailing Address - Street 1:3221 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-3216
Mailing Address - Country:US
Mailing Address - Phone:361-986-1102
Mailing Address - Fax:361-986-1010
Practice Address - Street 1:3221 HOLLY RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-3216
Practice Address - Country:US
Practice Address - Phone:361-986-1102
Practice Address - Fax:361-986-1010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGEL BRIGHT HOME HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-26
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1583288-01Medicaid
TX001012540OtherPRIMARY HOME CARE