Provider Demographics
NPI:1598055162
Name:ANGELIC HOME ASSISTANCE, LLC
Entity Type:Organization
Organization Name:ANGELIC HOME ASSISTANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:QUEEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:423-252-0001
Mailing Address - Street 1:9 S KILGORE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-4291
Mailing Address - Country:US
Mailing Address - Phone:423-252-0001
Mailing Address - Fax:423-453-5526
Practice Address - Street 1:9 S KILGORE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4291
Practice Address - Country:US
Practice Address - Phone:423-252-0001
Practice Address - Fax:423-453-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0047755251E00000X
TN0164603251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health