Provider Demographics
NPI:1366625303
Name:ARCHANGEL PERSONAL CARE ATTENDANT SERVICES,LLC
Entity Type:Organization
Organization Name:ARCHANGEL PERSONAL CARE ATTENDANT SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSLAND
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MPA
Authorized Official - Phone:504-366-0494
Mailing Address - Street 1:3501 HOLIDAY DR
Mailing Address - Street 2:407
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-8202
Mailing Address - Country:US
Mailing Address - Phone:504-366-0494
Mailing Address - Fax:504-366-0492
Practice Address - Street 1:3501 HOLIDAY DR
Practice Address - Street 2:407
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8202
Practice Address - Country:US
Practice Address - Phone:504-366-0494
Practice Address - Fax:504-366-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA11634251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1349992Medicaid
LA1629201Medicaid
LA1733407Medicaid
LA1454826Medicaid
LA1733407Medicaid