Provider Demographics
NPI:1437671955
Name:ANCA & LEO LLC
Entity Type:Organization
Organization Name:ANCA & LEO LLC
Other - Org Name:GUARDIAN ANGELS SUPPORT COORDINATOR AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANCUTA
Authorized Official - Middle Name:FELICIA
Authorized Official - Last Name:PEREA
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS ADMINSTRATI
Authorized Official - Phone:267-207-0195
Mailing Address - Street 1:9107 REVERE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1523
Mailing Address - Country:US
Mailing Address - Phone:267-207-0195
Mailing Address - Fax:
Practice Address - Street 1:9107 REVERE ST STE 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:267-207-0195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251B00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health