Provider Demographics
NPI:1629476429
Name:ANGELIC HEALTH CARE GROUP, INC.
Entity Type:Organization
Organization Name:ANGELIC HEALTH CARE GROUP, INC.
Other - Org Name:UPLIFTING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHIRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-342-9400
Mailing Address - Street 1:350 10TH AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8705
Mailing Address - Country:US
Mailing Address - Phone:619-342-9400
Mailing Address - Fax:
Practice Address - Street 1:1286 UNIVERSITY AVE STE 579
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3312
Practice Address - Country:US
Practice Address - Phone:619-342-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID96-359-7930OtherDUNS