Healthcare Provider Details

I. General information

NPI: 1346522158
Provider Name (Legal Business Name): HOUSE OF ANGELS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44120 ALSACE LN
HEMET CA
92544-9108
US

IV. Provider business mailing address

44120 ALSACE LANE
HEMET CA
92544
US

V. Phone/Fax

Practice location:
  • Phone: 951-392-2068
  • Fax: 951-392-2068
Mailing address:
  • Phone: 951-392-2068
  • Fax: 951-392-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. OMAR TOLENTINO
Title or Position: PRESIDENT
Credential:
Phone: 310-272-6730