Provider Demographics
NPI:1235273582
Name:ANGELS AT HOME, INC.
Entity Type:Organization
Organization Name:ANGELS AT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-874-5758
Mailing Address - Street 1:618 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2981
Mailing Address - Country:US
Mailing Address - Phone:903-874-5758
Mailing Address - Fax:903-874-5153
Practice Address - Street 1:618 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2981
Practice Address - Country:US
Practice Address - Phone:903-874-5758
Practice Address - Fax:903-874-5153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006005251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013064OtherTAS
TX001003562OtherCBA-CDS
TX001012623OtherPHC
TX001003561OtherPHC-CDS
TX001018003OtherPHC
TX001013064OtherTAS
TX001012623OtherPHC
TX001003561OtherPHC-CDS
1235273582Medicare NSC
TX001018003OtherPHC