Provider Demographics
NPI:1821623828
Name:ARCHANGEL HEALTHCARE LLC.
Entity Type:Organization
Organization Name:ARCHANGEL HEALTHCARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PANTELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-409-3320
Mailing Address - Street 1:38573 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1033
Mailing Address - Country:US
Mailing Address - Phone:727-409-3320
Mailing Address - Fax:
Practice Address - Street 1:38573 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1033
Practice Address - Country:US
Practice Address - Phone:727-409-3320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies