Provider Demographics
NPI:1295127793
Name:ANGEL GROUP HOME CORP
Entity type:Organization
Organization Name:ANGEL GROUP HOME CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:786-355-6781
Mailing Address - Street 1:21321 SW 128TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7421
Mailing Address - Country:US
Mailing Address - Phone:786-355-6781
Mailing Address - Fax:
Practice Address - Street 1:21321 SW 128TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-7421
Practice Address - Country:US
Practice Address - Phone:786-355-6781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities