MEDICARE: ANGEL ADHC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184831752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL ADHC, INC

Provider Business Mailing Address
First Line	:	1417 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-1236
Country	:	US
Telephone Number	:	213-745-4290
Fax Number	:	213-745-4297

Provider Business Practice Location Address
First Line	:	1417 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-1236
Country	:	US
Telephone Number	:	213-745-4290
Fax Number	:	213-745-4297

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KOOM SOUN SON
Credential	:	RN
Telephone Number	:	213-745-4290

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/22/2020

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Directions to “ANGEL ADHC, INC ” Practice Location

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