Provider Demographics
NPI:1982199196
Name:ANGEL PREFERRED HOME CARE LLC
Entity Type:Organization
Organization Name:ANGEL PREFERRED HOME CARE LLC
Other - Org Name:ANGEL PREFERRED HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILFRID
Authorized Official - Middle Name:
Authorized Official - Last Name:THERESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-263-0441
Mailing Address - Street 1:501 GOODLETTE RD N STE D100
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5666
Mailing Address - Country:US
Mailing Address - Phone:239-263-0441
Mailing Address - Fax:239-263-4407
Practice Address - Street 1:501 GOODLETTE RD N STE 18
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5661
Practice Address - Country:US
Practice Address - Phone:239-263-0441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994669251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health