Provider Demographics
NPI:1508637968
Name:ANGELIC CARE
Entity Type:Organization
Organization Name:ANGELIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:JALEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-298-2514
Mailing Address - Street 1:9107 3RD STREET RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2508
Mailing Address - Country:US
Mailing Address - Phone:502-298-2514
Mailing Address - Fax:
Practice Address - Street 1:9107 3RD STREET RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2508
Practice Address - Country:US
Practice Address - Phone:502-298-2514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services