Provider Demographics
NPI:1558919217
Name:ANGELIC HEROS HOME CARE LLC
Entity Type:Organization
Organization Name:ANGELIC HEROS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LASHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:HOME CARE LICENCE
Authorized Official - Phone:484-480-1247
Mailing Address - Street 1:1616 ARCH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3500
Mailing Address - Country:US
Mailing Address - Phone:484-480-1247
Mailing Address - Fax:
Practice Address - Street 1:1616 ARCH ST APT 3
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3500
Practice Address - Country:US
Practice Address - Phone:484-480-1247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA37423601Medicaid