Provider Demographics
NPI:1801698097
Name:SILASI, ANGIE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:SILASI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25107 N 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-2916
Mailing Address - Country:US
Mailing Address - Phone:602-291-3610
Mailing Address - Fax:
Practice Address - Street 1:14836 N HANA MAUI DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3657
Practice Address - Country:US
Practice Address - Phone:602-291-3610
Practice Address - Fax:480-452-1596
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL13290H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home