Provider Demographics
NPI:1750804621
Name:ANGEL HANDS RESIDENTIAL, LLC
Entity type:Organization
Organization Name:ANGEL HANDS RESIDENTIAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:ES
Authorized Official - Last Name:TANDOH
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:734-578-2781
Mailing Address - Street 1:7 W SQUARE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0462
Mailing Address - Country:US
Mailing Address - Phone:248-452-5680
Mailing Address - Fax:248-452-5681
Practice Address - Street 1:7 W SQUARE LAKE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0462
Practice Address - Country:US
Practice Address - Phone:248-452-5680
Practice Address - Fax:248-452-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 385HR2065X, 174200000X, 343900000X, 251G00000X
MI385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, ChildGroup - Multi-Specialty
No174200000XOther Service ProvidersMealsGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8045683Medicaid
PA716825OtherRN