Provider Demographics
NPI:1770784688
Name:ANGELCITY CORPORATION
Entity type:Organization
Organization Name:ANGELCITY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:901-395-0199
Mailing Address - Street 1:3385 AIRWAYS BLVD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-3841
Mailing Address - Country:US
Mailing Address - Phone:901-395-0199
Mailing Address - Fax:
Practice Address - Street 1:3385 AIRWAYS BLVD
Practice Address - Street 2:SUITE 119
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-3841
Practice Address - Country:US
Practice Address - Phone:901-395-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5188562310400000X, 3104A0625X, 320700000X, 3104A0630X, 313M00000X, 311500000X, 261QP2000X
TN1770784688311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility