Provider Demographics
NPI:1831955814
Name:THE ANGEL HOUSE
Entity type:Organization
Organization Name:THE ANGEL HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL-CAIQUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-405-7316
Mailing Address - Street 1:552 E CARSON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2897
Mailing Address - Country:US
Mailing Address - Phone:562-896-3909
Mailing Address - Fax:
Practice Address - Street 1:5103 W 123RD PL
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3525
Practice Address - Country:US
Practice Address - Phone:562-896-3909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251G00000XAgenciesHospice Care, Community Based