Provider Demographics
NPI:1629074430
Name:ANGELICA, INC.
Entity Type:Organization
Organization Name:ANGELICA, INC.
Other - Org Name:ADVANCED HOMECARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-772-1003
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-0401
Mailing Address - Country:US
Mailing Address - Phone:580-772-1003
Mailing Address - Fax:580-772-0298
Practice Address - Street 1:1101 E LOOMIS RD
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-3318
Practice Address - Country:US
Practice Address - Phone:580-772-1003
Practice Address - Fax:580-772-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC7567251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKHC7567OtherSTATE LICENSE NUMBER
OK100262470AMedicaid
OKHC7567OtherSTATE LICENSE NUMBER