Provider Demographics
NPI:1356652440
Name:ANGEL PLACE ASSISTED LIVING
Entity Type:Organization
Organization Name:ANGEL PLACE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-618-6436
Mailing Address - Street 1:3911 SHERRILBROOK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-2846
Mailing Address - Country:US
Mailing Address - Phone:210-435-8234
Mailing Address - Fax:210-435-8234
Practice Address - Street 1:3911 SHERRILBROOK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-2846
Practice Address - Country:US
Practice Address - Phone:210-435-8234
Practice Address - Fax:210-435-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126234310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility