Provider Demographics
NPI:1750107868
Name:ANGELIC HOME CARE LLC
Entity type:Organization
Organization Name:ANGELIC HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J O
Authorized Official - Last Name:KODI
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:203-982-3834
Mailing Address - Street 1:85 PHYLLIS AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3613
Mailing Address - Country:US
Mailing Address - Phone:203-982-3834
Mailing Address - Fax:
Practice Address - Street 1:3029 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1214
Practice Address - Country:US
Practice Address - Phone:203-982-3834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care