Provider Demographics
NPI:1164746418
Name:ANGEL CARE NETWORK
Entity Type:Organization
Organization Name:ANGEL CARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:INGE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-758-5969
Mailing Address - Street 1:412 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:RIVA
Mailing Address - State:MD
Mailing Address - Zip Code:21140-1411
Mailing Address - Country:US
Mailing Address - Phone:443-758-5969
Mailing Address - Fax:443-458-0447
Practice Address - Street 1:412 WESTBURY DR
Practice Address - Street 2:
Practice Address - City:RIVA
Practice Address - State:MD
Practice Address - Zip Code:21140-1411
Practice Address - Country:US
Practice Address - Phone:443-758-5969
Practice Address - Fax:443-458-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2731251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health