Provider Demographics
NPI:1154507226
Name:ANGEL TOUCH HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ANGEL TOUCH HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADM./ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SOFRONIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAVAGO
Authorized Official - Suffix:
Authorized Official - Credentials:ENGINEER
Authorized Official - Phone:773-907-0300
Mailing Address - Street 1:5757 N LINCOLN AVE STE 18
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4729
Mailing Address - Country:US
Mailing Address - Phone:773-907-0300
Mailing Address - Fax:773-907-0325
Practice Address - Street 1:5757 N LINCOLN AVE STE 18
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4729
Practice Address - Country:US
Practice Address - Phone:773-907-0300
Practice Address - Fax:773-907-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010730251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010730OtherIDPH