Provider Demographics
NPI:1659815405
Name:ANGEL HOME CARE AGENCY INC
Entity Type:Organization
Organization Name:ANGEL HOME CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:VERONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-257-0381
Mailing Address - Street 1:1422 HYLAN BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1923
Mailing Address - Country:US
Mailing Address - Phone:718-980-2273
Mailing Address - Fax:718-351-1962
Practice Address - Street 1:1422 HYLAN BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1923
Practice Address - Country:US
Practice Address - Phone:718-980-2273
Practice Address - Fax:718-351-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2187L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health