Provider Demographics
NPI:1356475891
Name:PRIMARY ANGEL INC.
Entity Type:Organization
Organization Name:PRIMARY ANGEL INC.
Other - Org Name:ESSENCE HOMEHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLIVA
Authorized Official - Middle Name:ANGELES
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-233-1249
Mailing Address - Street 1:14665 MIDWAY RD STE 177
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3921
Mailing Address - Country:US
Mailing Address - Phone:972-233-1249
Mailing Address - Fax:972-233-1261
Practice Address - Street 1:14665 MIDWAY RD STE 177
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3921
Practice Address - Country:US
Practice Address - Phone:972-233-1249
Practice Address - Fax:972-233-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009045251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679388Medicare ID - Type UnspecifiedPROVIDER NUMBER