Provider Demographics
NPI:1265662357
Name:ANGELIC HOME CARE INC.
Entity Type:Organization
Organization Name:ANGELIC HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-618-9223
Mailing Address - Street 1:4670 WILLIAMS WHARF RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LEONARD
Mailing Address - State:MD
Mailing Address - Zip Code:20685-3044
Mailing Address - Country:US
Mailing Address - Phone:301-618-9223
Mailing Address - Fax:443-295-7814
Practice Address - Street 1:4670 WILLIAMS WHARF RD
Practice Address - Street 2:
Practice Address - City:SAINT LEONARD
Practice Address - State:MD
Practice Address - Zip Code:20685-3044
Practice Address - Country:US
Practice Address - Phone:301-618-9223
Practice Address - Fax:443-295-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD84718253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care