Provider Demographics
NPI:1821661067
Name:ANGEL HOUSE, LLC
Entity Type:Organization
Organization Name:ANGEL HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMARIA
Authorized Official - Middle Name:JONISE
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-578-4614
Mailing Address - Street 1:119 HAWKINS ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3336
Mailing Address - Country:US
Mailing Address - Phone:337-578-4614
Mailing Address - Fax:
Practice Address - Street 1:115 HAWKINS ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538
Practice Address - Country:US
Practice Address - Phone:337-578-4614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty