Provider Demographics
NPI:1922057652
Name:ANGELICAL HOME HEALTH, INC.
Entity Type:Organization
Organization Name:ANGELICAL HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN/CFO/OWNER
Authorized Official - Phone:956-581-1251
Mailing Address - Street 1:504 LAKE POINT ST
Mailing Address - Street 2:
Mailing Address - City:LA JOYA
Mailing Address - State:TX
Mailing Address - Zip Code:78560-4021
Mailing Address - Country:US
Mailing Address - Phone:956-581-1251
Mailing Address - Fax:956-581-4859
Practice Address - Street 1:504 LAKE POINT ST
Practice Address - Street 2:
Practice Address - City:LA JOYA
Practice Address - State:TX
Practice Address - Zip Code:78560-4021
Practice Address - Country:US
Practice Address - Phone:956-581-1251
Practice Address - Fax:956-581-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010100251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677881OtherMEDICARE PROVIDER NUMBER
TX677881Medicare Oscar/Certification