Provider Demographics
NPI:1750942769
Name:ANGEL HEALTHCARE INC
Entity type:Organization
Organization Name:ANGEL HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKENDI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:717-333-1919
Mailing Address - Street 1:406 KEINATH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-3165
Mailing Address - Country:US
Mailing Address - Phone:717-333-1919
Mailing Address - Fax:
Practice Address - Street 1:406 KEINATH ST
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-3165
Practice Address - Country:US
Practice Address - Phone:717-333-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103263652Medicaid