Provider Demographics
NPI:1578755138
Name:ANGELIC SERVICES LLC
Entity Type:Organization
Organization Name:ANGELIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-644-2326
Mailing Address - Street 1:14046 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6607
Mailing Address - Country:US
Mailing Address - Phone:225-644-2326
Mailing Address - Fax:225-647-4754
Practice Address - Street 1:14046 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6607
Practice Address - Country:US
Practice Address - Phone:225-644-2326
Practice Address - Fax:225-647-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12138251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1145165Medicaid