Provider Demographics
NPI:1225899412
Name:DOMINIQUE ANGELS HOME CARE LLC
Entity Type:Organization
Organization Name:DOMINIQUE ANGELS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTIONETTE
Authorized Official - Middle Name:LABARBRA
Authorized Official - Last Name:RAVENELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-500-3873
Mailing Address - Street 1:2200 CLOVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-1434
Mailing Address - Country:US
Mailing Address - Phone:817-500-3873
Mailing Address - Fax:817-584-6246
Practice Address - Street 1:2200 CLOVER PARK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-1434
Practice Address - Country:US
Practice Address - Phone:817-500-3873
Practice Address - Fax:817-584-6246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOMINIQUE ANGELS HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty