Provider Demographics
NPI:1811588197
Name:ANGELIC HAND ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:ANGELIC HAND ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDERAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-293-4724
Mailing Address - Street 1:3363 S KIMBERLEE CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2493
Mailing Address - Country:US
Mailing Address - Phone:480-293-4724
Mailing Address - Fax:
Practice Address - Street 1:4949 W ERIE ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2970
Practice Address - Country:US
Practice Address - Phone:480-293-4724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility