Provider Demographics
NPI:1457023202
Name:ANGELUS ACCESS CARE AGENCY LLC
Entity Type:Organization
Organization Name:ANGELUS ACCESS CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-418-0097
Mailing Address - Street 1:444 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5914
Mailing Address - Country:US
Mailing Address - Phone:310-418-0097
Mailing Address - Fax:
Practice Address - Street 1:21151 S WESTERN AVE STE 130
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1724
Practice Address - Country:US
Practice Address - Phone:310-418-0097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care