MEDICARE: ANGELUS HOSPICE AND PALLIATIVE CARE LLC

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1912611229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELUS HOSPICE AND PALLIATIVE CARE LLC

Provider Business Mailing Address
First Line	:	9847 MARBACH BND
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1699
Country	:	US
Telephone Number	:	210-300-0478
Fax Number	:

Provider Business Practice Location Address
First Line	:	9847 MARBACH BND
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1699
Country	:	US
Telephone Number	:	210-300-0478
Fax Number	:

Authorized Official
Title or Position	:	ALTERNATE ADMINISTRATOR
Name	:	MRS. STELLA IHESIABA
Credential	:	RN
Telephone Number	:	210-300-0478

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	01/11/2023

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