Provider Demographics
NPI:1861668014
Name:ANGEL HOME HOSPICE LLC
Entity Type:Organization
Organization Name:ANGEL HOME HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OMANA
Authorized Official - Middle Name:CHERUKARA
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:281-969-7043
Mailing Address - Street 1:4501 CARTWRIGHT RD
Mailing Address - Street 2:SUITE#102
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3534
Mailing Address - Country:US
Mailing Address - Phone:281-969-7043
Mailing Address - Fax:
Practice Address - Street 1:4501 CARTWRIGHT RD
Practice Address - Street 2:SUITE#102
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3534
Practice Address - Country:US
Practice Address - Phone:281-969-7043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011910251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based