Provider Demographics
NPI:1497093801
Name:ANGEL OF LIFE LLC
Entity Type:Organization
Organization Name:ANGEL OF LIFE LLC
Other - Org Name:DHELMAR CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LETRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-365-9117
Mailing Address - Street 1:PO BOX 431571
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-9571
Mailing Address - Country:US
Mailing Address - Phone:323-365-9117
Mailing Address - Fax:323-570-0386
Practice Address - Street 1:2057 W 64TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-1702
Practice Address - Country:US
Practice Address - Phone:323-365-9117
Practice Address - Fax:323-570-0386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility