Provider Demographics
NPI:1720422215
Name:ANGEL HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:ANGEL HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BC
Authorized Official - Phone:518-537-2070
Mailing Address - Street 1:71 PALATINE PARK RD
Mailing Address - Street 2:STE 3
Mailing Address - City:GERMANTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12526-5340
Mailing Address - Country:US
Mailing Address - Phone:518-537-2070
Mailing Address - Fax:518-537-2071
Practice Address - Street 1:71 PALATINE PARK RD
Practice Address - Street 2:STE 3
Practice Address - City:GERMANTOWN
Practice Address - State:NY
Practice Address - Zip Code:12526-5340
Practice Address - Country:US
Practice Address - Phone:518-537-2070
Practice Address - Fax:518-537-2071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1286L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02569560Medicaid