Provider Demographics
NPI:1184721391
Name:ANGELIQUE HEALTHCARE SUPPLY INC.
Entity type:Organization
Organization Name:ANGELIQUE HEALTHCARE SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACK
Authorized Official - Suffix:
Authorized Official - Credentials:CFS
Authorized Official - Phone:817-299-0297
Mailing Address - Street 1:2535 E. ARKANSAS LANE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-8797
Mailing Address - Country:US
Mailing Address - Phone:817-299-0297
Mailing Address - Fax:817-299-0394
Practice Address - Street 1:2535 E. ARKANSAS LN
Practice Address - Street 2:SUITE 311
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-8797
Practice Address - Country:US
Practice Address - Phone:817-299-0297
Practice Address - Fax:817-299-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0088916332BC3200X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185278203Medicaid
TX0088916OtherTDSHS LICENSE
TX185278202Medicaid
TX185278201Medicaid
TX185278201Medicaid