Provider Demographics
NPI:1831972256
Name:ANGEL'S PALM LLC
Entity type:Organization
Organization Name:ANGEL'S PALM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-350-9013
Mailing Address - Street 1:8683 W SAHARA AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5884
Mailing Address - Country:US
Mailing Address - Phone:702-772-2507
Mailing Address - Fax:702-268-7078
Practice Address - Street 1:8683 W SAHARA AVE STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5884
Practice Address - Country:US
Practice Address - Phone:702-772-2507
Practice Address - Fax:702-268-7078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGEL'S PALM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based