Provider Demographics
NPI:1720571581
Name:805 ANGELS LLC
Entity Type:Organization
Organization Name:805 ANGELS LLC
Other - Org Name:VISITING ANGELS OF SANTA BARBARA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLY-ROOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-284-0221
Mailing Address - Street 1:5565 CARPINTERIA AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013
Mailing Address - Country:US
Mailing Address - Phone:805-284-0221
Mailing Address - Fax:805-284-0223
Practice Address - Street 1:5565 CARPINTERIA AVE
Practice Address - Street 2:STE 1
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013
Practice Address - Country:US
Practice Address - Phone:805-284-0221
Practice Address - Fax:805-284-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4247000Z03747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty