Provider Demographics
NPI:1508549262
Name:ANGELICA'S HOME, INC.
Entity Type:Organization
Organization Name:ANGELICA'S HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:OOSTING
Authorized Official - Suffix:
Authorized Official - Credentials:MSME
Authorized Official - Phone:321-432-8883
Mailing Address - Street 1:31916 CORTE POSITAS
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6482
Mailing Address - Country:US
Mailing Address - Phone:321-432-8883
Mailing Address - Fax:
Practice Address - Street 1:31916 CORTE POSITAS
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6482
Practice Address - Country:US
Practice Address - Phone:321-432-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251G00000XAgenciesHospice Care, Community Based