Provider Demographics
NPI:1245869411
Name:ANGEL PERSONAL CARE SERVICES LLC
Entity type:Organization
Organization Name:ANGEL PERSONAL CARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:026-654-7677
Mailing Address - Street 1:4160 S PECOS RD # 21
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5025
Mailing Address - Country:US
Mailing Address - Phone:702-665-4767
Mailing Address - Fax:
Practice Address - Street 1:4160 S PECOS RD # 21
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5025
Practice Address - Country:US
Practice Address - Phone:702-665-4767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV30Medicaid