Provider Demographics
NPI:1891277471
Name:ANGELIC MANSIONS, LLC
Entity Type:Organization
Organization Name:ANGELIC MANSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJADAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-259-6877
Mailing Address - Street 1:7585 WARREN VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7585 WARREN VISTA AVE
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3847
Practice Address - Country:US
Practice Address - Phone:760-365-4620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361800118310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility