Provider Demographics
NPI:1407980709
Name:LITTLE ANGELS, INC.
Entity Type:Organization
Organization Name:LITTLE ANGELS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNHA
Authorized Official - Phone:847-741-1609
Mailing Address - Street 1:1435 SUMMIT STREET
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-9218
Mailing Address - Country:US
Mailing Address - Phone:847-741-1609
Mailing Address - Fax:847-622-5523
Practice Address - Street 1:1435 SUMMIT STREET
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-9218
Practice Address - Country:US
Practice Address - Phone:847-741-1609
Practice Address - Fax:847-622-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0010918315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14G247Medicaid
IL=========001Medicaid