Provider Demographics
NPI:1992387609
Name:ANGELA'S HOUSE RESIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:ANGELA'S HOUSE RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-506-0641
Mailing Address - Street 1:12245 BEECH DALY RD UNIT 40426
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-3218
Mailing Address - Country:US
Mailing Address - Phone:586-506-0641
Mailing Address - Fax:
Practice Address - Street 1:18641 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2918
Practice Address - Country:US
Practice Address - Phone:586-506-0641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health