Provider Demographics
NPI:1386041184
Name:ABLE HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:ABLE HEALTH GROUP, LLC
Other - Org Name:ANGELIC CARE HOSPICE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MWANSA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-943-6454
Mailing Address - Street 1:1007 E COOLEY DR # 118
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3901
Mailing Address - Country:US
Mailing Address - Phone:909-505-2252
Mailing Address - Fax:
Practice Address - Street 1:41990 COOK ST STE 2004
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6105
Practice Address - Country:US
Practice Address - Phone:760-610-2093
Practice Address - Fax:760-610-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid