Provider Demographics
NPI:1891778999
Name:ANGELCARE HOSPICE
Entity Type:Organization
Organization Name:ANGELCARE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:VIRGIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-809-1143
Mailing Address - Street 1:17806 PIONEER BLVD
Mailing Address - Street 2:105
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3971
Mailing Address - Country:US
Mailing Address - Phone:562-809-1143
Mailing Address - Fax:562-809-4922
Practice Address - Street 1:17806 PIONEER BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3971
Practice Address - Country:US
Practice Address - Phone:562-809-1143
Practice Address - Fax:562-809-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPCO1745FMedicaid
CAHPCO1745FMedicaid