Provider Demographics
NPI:1790092963
Name:ANGELIC HOST ENTERPRISE INC.
Entity Type:Organization
Organization Name:ANGELIC HOST ENTERPRISE INC.
Other - Org Name:ANGELIC HOST HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-970-6242
Mailing Address - Street 1:7950 NATIONS FORD RD
Mailing Address - Street 2:SUITE D-11
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-8014
Mailing Address - Country:US
Mailing Address - Phone:704-970-6242
Mailing Address - Fax:
Practice Address - Street 1:7950 NATIONS FORD RD
Practice Address - Street 2:SUITE D-11
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-8014
Practice Address - Country:US
Practice Address - Phone:704-970-6242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4112253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care