Provider Demographics
NPI:1326219874
Name:ANGEL CARE HOSPICE LLC
Entity Type:Organization
Organization Name:ANGEL CARE HOSPICE LLC
Other - Org Name:ANGEL CARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BURT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-657-8969
Mailing Address - Street 1:702 FAIR PARK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-3266
Mailing Address - Country:US
Mailing Address - Phone:903-657-2461
Mailing Address - Fax:903-657-8796
Practice Address - Street 1:702 FAIR PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-3266
Practice Address - Country:US
Practice Address - Phone:903-657-2461
Practice Address - Fax:903-657-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12010Medicaid
TX12010Medicaid