Provider Demographics
NPI:1215580592
Name:HOLY ANGEL HOME CARE LLC
Entity Type:Organization
Organization Name:HOLY ANGEL HOME CARE LLC
Other - Org Name:HOLY ANGEL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVASSYKUTTY
Authorized Official - Middle Name:K
Authorized Official - Last Name:VAREED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:267-760-4417
Mailing Address - Street 1:11 SUNFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-5450
Mailing Address - Country:US
Mailing Address - Phone:267-760-4417
Mailing Address - Fax:215-673-7370
Practice Address - Street 1:9313 KREWSTOWN RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3710
Practice Address - Country:US
Practice Address - Phone:215-673-7373
Practice Address - Fax:215-673-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty