Provider Demographics
NPI:1184831752
Name:ANGEL ADHC, INC
Entity Type:Organization
Organization Name:ANGEL ADHC, INC
Other - Org Name:ANGEL ADULT DAY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KOOM
Authorized Official - Middle Name:SOUN
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:213-745-4290
Mailing Address - Street 1:1417 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-1236
Mailing Address - Country:US
Mailing Address - Phone:213-745-4290
Mailing Address - Fax:213-745-4297
Practice Address - Street 1:1417 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-1236
Practice Address - Country:US
Practice Address - Phone:213-745-4290
Practice Address - Fax:213-745-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70268FMedicaid