Provider Demographics
NPI:1568962272
Name:BLUE EYED ANGEL LLC
Entity Type:Organization
Organization Name:BLUE EYED ANGEL LLC
Other - Org Name:CLOSE TO HOME ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-629-2332
Mailing Address - Street 1:1308 W SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6304
Mailing Address - Country:US
Mailing Address - Phone:830-629-2332
Mailing Address - Fax:
Practice Address - Street 1:1308 W SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6304
Practice Address - Country:US
Practice Address - Phone:830-629-2332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care