Provider Demographics
NPI:1972846905
Name:ANGELICA CARE CORP
Entity Type:Organization
Organization Name:ANGELICA CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IFY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-337-0934
Mailing Address - Street 1:6700 FALLBROOK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3530
Mailing Address - Country:US
Mailing Address - Phone:818-337-0934
Mailing Address - Fax:866-448-6575
Practice Address - Street 1:6700 FALLBROOK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3530
Practice Address - Country:US
Practice Address - Phone:818-337-0934
Practice Address - Fax:866-448-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3544410251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based