Provider Demographics
NPI:1013269067
Name:ANGEL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ANGEL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:UWAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-412-9921
Mailing Address - Street 1:2609 87TH TRL N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3742
Mailing Address - Country:US
Mailing Address - Phone:763-412-9921
Mailing Address - Fax:
Practice Address - Street 1:2609 87TH TRAIL N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443
Practice Address - Country:US
Practice Address - Phone:763-412-9921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGEL HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311ZA0620X, 314000000X, 3140N1450X
MN15660842314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric