Provider Demographics
NPI:1164657417
Name:ANGELES PRIMARY HOME CARE LLC
Entity Type:Organization
Organization Name:ANGELES PRIMARY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ETNA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-867-5937
Mailing Address - Street 1:4313 N 10TH ST
Mailing Address - Street 2:F4
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3061
Mailing Address - Country:US
Mailing Address - Phone:956-213-8288
Mailing Address - Fax:956-213-8288
Practice Address - Street 1:4313 N 10TH ST
Practice Address - Street 2:F4
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3061
Practice Address - Country:US
Practice Address - Phone:956-213-8288
Practice Address - Fax:956-213-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care