Provider Demographics
NPI:1598480766
Name:ARK ANGEL, II LLC
Entity Type:Organization
Organization Name:ARK ANGEL, II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:HAIDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-677-6561
Mailing Address - Street 1:28759 VISTA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-6703
Mailing Address - Country:US
Mailing Address - Phone:510-677-6561
Mailing Address - Fax:
Practice Address - Street 1:1641 D ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4320
Practice Address - Country:US
Practice Address - Phone:510-397-0751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA019201202OtherRESIDENTIAL CARE FOR THE ELDERLY