Provider Demographics
NPI:1598352593
Name:ARMS OF AN ANGEL PROVIDER SERVICES LLC
Entity Type:Organization
Organization Name:ARMS OF AN ANGEL PROVIDER SERVICES LLC
Other - Org Name:ARMS OF AN ANGEL PROVIDER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:210-245-0245
Mailing Address - Street 1:118 BROADWAY ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1950
Mailing Address - Country:US
Mailing Address - Phone:210-245-0245
Mailing Address - Fax:210-200-6063
Practice Address - Street 1:118 BROADWAY ST STE 203
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1950
Practice Address - Country:US
Practice Address - Phone:210-245-0245
Practice Address - Fax:210-200-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20210589389OtherDBA
TX20210589389Medicaid