Provider Demographics
NPI:1619331766
Name:ANGELICARE LLC
Entity Type:Organization
Organization Name:ANGELICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIONNA
Authorized Official - Middle Name:BROCK
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-366-6116
Mailing Address - Street 1:3408 ANGELIQUE DR
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-2854
Mailing Address - Country:US
Mailing Address - Phone:888-366-6116
Mailing Address - Fax:888-366-6116
Practice Address - Street 1:3408 ANGELIQUE DR
Practice Address - Street 2:
Practice Address - City:VIOLET
Practice Address - State:LA
Practice Address - Zip Code:70092-2854
Practice Address - Country:US
Practice Address - Phone:888-366-6116
Practice Address - Fax:888-366-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities