Provider Demographics
NPI:1427590108
Name:ANGEL SENIOR CARE
Entity Type:Organization
Organization Name:ANGEL SENIOR CARE
Other - Org Name:GUARDIAN ANGEL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-499-4567
Mailing Address - Street 1:8512 N WALL ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6164
Mailing Address - Country:US
Mailing Address - Phone:509-720-7972
Mailing Address - Fax:888-239-5488
Practice Address - Street 1:8512 N WALL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6164
Practice Address - Country:US
Practice Address - Phone:509-720-7972
Practice Address - Fax:888-239-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603165643251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health