Provider Demographics
NPI:1568171783
Name:AN ANGEL GARDEN INC
Entity Type:Organization
Organization Name:AN ANGEL GARDEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNWER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YOUNGSUK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:530-886-9529
Mailing Address - Street 1:9873 TRAVELER CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4724
Mailing Address - Country:US
Mailing Address - Phone:530-886-9529
Mailing Address - Fax:916-775-7731
Practice Address - Street 1:9873 TRAVELER CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4724
Practice Address - Country:US
Practice Address - Phone:530-886-9529
Practice Address - Fax:916-775-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility