MEDICARE: ANGELICARE HOME HEALTH 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	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1578896304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELICARE HOME HEALTH INC

Provider Business Mailing Address
First Line	:	12598 CENTRAL AVE STE 210
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-3530
Country	:	US
Telephone Number	:	909-464-2273
Fax Number	:	909-464-2276

Provider Business Practice Location Address
First Line	:	12598 CENTRAL AVE STE 210
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-3530
Country	:	US
Telephone Number	:	909-464-2273
Fax Number	:	909-464-2276

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	ROSALIE SEVILLA-MABASA
Credential	:
Telephone Number	:	909-464-2273

Provider Enumeration Date	:	09/11/2009
Last Update Date	:	02/01/2024

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