Provider Demographics
NPI:1235843384
Name:ANGELIC CARE LIVING LLC
Entity Type:Organization
Organization Name:ANGELIC CARE LIVING LLC
Other - Org Name:ANGELIC CARE LIVING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORLENE
Authorized Official - Middle Name:ANN ROXANNE
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-329-9619
Mailing Address - Street 1:207 BOGDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-4844
Mailing Address - Country:US
Mailing Address - Phone:856-329-9619
Mailing Address - Fax:856-329-9908
Practice Address - Street 1:207 BOGDEN BLVD STE H
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-4844
Practice Address - Country:US
Practice Address - Phone:856-329-9619
Practice Address - Fax:856-329-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care