Provider Demographics
NPI:1558934141
Name:ANGELIC HEALTH OF PA LLC
Entity Type:Organization
Organization Name:ANGELIC HEALTH OF PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-822-7979
Mailing Address - Street 1:8025 BLACK HORSE PIKE STE 501
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2967
Mailing Address - Country:US
Mailing Address - Phone:609-822-7979
Mailing Address - Fax:609-822-7980
Practice Address - Street 1:486 NORRISTOWN RD STE 133
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2353
Practice Address - Country:US
Practice Address - Phone:267-858-1494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELIC HEALTH OF PA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty