Provider Demographics
NPI:1396204160
Name:ANGELIC CARE GROUP LLC
Entity Type:Organization
Organization Name:ANGELIC CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:DEDDEH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:281-746-1292
Mailing Address - Street 1:5106 SMOKEY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6017
Mailing Address - Country:US
Mailing Address - Phone:281-746-1292
Mailing Address - Fax:
Practice Address - Street 1:5106 SMOKEY RIVER DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6017
Practice Address - Country:US
Practice Address - Phone:281-746-1292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities