Provider Demographics
NPI:1609490242
Name:ANGELS HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:ANGELS HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUNENYE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:443-559-1875
Mailing Address - Street 1:1828 HANFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-1744
Mailing Address - Country:US
Mailing Address - Phone:443-559-1875
Mailing Address - Fax:
Practice Address - Street 1:1828 HANFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-1744
Practice Address - Country:US
Practice Address - Phone:443-559-1875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD888194400Medicaid