Provider Demographics
NPI:1578896304
Name:ANGELICARE HOME HEALTH INC
Entity Type:Organization
Organization Name:ANGELICARE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVILLA-MABASA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-464-2273
Mailing Address - Street 1:12598 CENTRAL AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3530
Mailing Address - Country:US
Mailing Address - Phone:909-464-2273
Mailing Address - Fax:909-464-2276
Practice Address - Street 1:12598 CENTRAL AVE STE 210
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3530
Practice Address - Country:US
Practice Address - Phone:909-464-2273
Practice Address - Fax:909-464-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059316Medicare Oscar/Certification