Provider Demographics
NPI:1417556689
Name:ANGEL'S PLACE
Entity Type:Organization
Organization Name:ANGEL'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YULY
Authorized Official - Middle Name:VANESSA
Authorized Official - Last Name:OLOWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-918-6690
Mailing Address - Street 1:909 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-4040
Mailing Address - Country:US
Mailing Address - Phone:903-918-6690
Mailing Address - Fax:
Practice Address - Street 1:909 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-4040
Practice Address - Country:US
Practice Address - Phone:903-918-6690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty