Provider Demographics
NPI:1225212145
Name:ANGEL HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:ANGEL HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CHERUKARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-969-7043
Mailing Address - Street 1:4227 SHADY VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1570
Mailing Address - Country:US
Mailing Address - Phone:281-969-7043
Mailing Address - Fax:281-969-7045
Practice Address - Street 1:4227 SHADY VILLAGE CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1570
Practice Address - Country:US
Practice Address - Phone:281-969-7043
Practice Address - Fax:281-969-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014830251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209319701Medicaid
TX747067Medicare PIN
TX747067Medicare Oscar/Certification