Provider Demographics
NPI:1508244393
Name:ANGELA'S ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:ANGELA'S ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVERT-JARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-293-7058
Mailing Address - Street 1:17506 COVENTRY SQUIRE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6358
Mailing Address - Country:US
Mailing Address - Phone:512-293-7058
Mailing Address - Fax:
Practice Address - Street 1:2939 HIGGINS ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-1408
Practice Address - Country:US
Practice Address - Phone:512-293-7058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health