Provider Demographics
NPI:1629565015
Name:ANGELIC PALLIATIVE CARE
Entity Type:Organization
Organization Name:ANGELIC PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-822-7979
Mailing Address - Street 1:8025 BLACK HORSE PIKE STE 501
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2967
Mailing Address - Country:US
Mailing Address - Phone:609-822-7979
Mailing Address - Fax:609-822-7980
Practice Address - Street 1:8025 BLACK HORSE PIKE STE 501
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232
Practice Address - Country:US
Practice Address - Phone:609-822-7979
Practice Address - Fax:609-822-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty