Provider Demographics
NPI:1164408373
Name:ANGELITOS HEALTH CARE INC
Entity Type:Organization
Organization Name:ANGELITOS HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-488-8434
Mailing Address - Street 1:2544 CENTRAL PALM DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-6668
Mailing Address - Country:US
Mailing Address - Phone:956-488-8434
Mailing Address - Fax:956-488-8823
Practice Address - Street 1:2544 CENTRAL PALM DR
Practice Address - Street 2:SUITE 107
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6668
Practice Address - Country:US
Practice Address - Phone:956-488-8434
Practice Address - Fax:956-488-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
TX012537251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012537OtherSTATE LICENSE NO.
TX001018931OtherSTATE CONTRACT VENDOR NO.
TX001018932OtherSTATE CONTRACT VENDOR NO.
TX001013518Medicaid
TX012537OtherSTATE LICENSE NO.
TX001018932OtherSTATE CONTRACT VENDOR NO.