Provider Demographics
NPI:1326409079
Name:ANGEL CARE PCP CORP
Entity Type:Organization
Organization Name:ANGEL CARE PCP CORP
Other - Org Name:ANGEL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDANT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-369-5294
Mailing Address - Street 1:1010 S JOLIET ST STE 106
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3150
Mailing Address - Country:US
Mailing Address - Phone:303-369-5294
Mailing Address - Fax:
Practice Address - Street 1:1010 S JOLIET ST STE 106
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3150
Practice Address - Country:US
Practice Address - Phone:303-369-5294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10O629251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health