Provider Demographics
NPI:1184183311
Name:ANGELIC PLACE HOME HEALTH LLC
Entity Type:Organization
Organization Name:ANGELIC PLACE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMIGDUS
Authorized Official - Middle Name:L
Authorized Official - Last Name:NKEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-494-7066
Mailing Address - Street 1:754 WARRENTON RD STE 109
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-1098
Mailing Address - Country:US
Mailing Address - Phone:540-479-2756
Mailing Address - Fax:540-642-4569
Practice Address - Street 1:754 WARRENTON RD STE 109
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-1098
Practice Address - Country:US
Practice Address - Phone:540-479-2756
Practice Address - Fax:540-642-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-2088Medicaid