Healthcare Provider Details

I. General information

NPI: 1720982564
Provider Name (Legal Business Name): ANGEL'S BEACON HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 PENNSYLVANIA ST
DENVER CO
80229-5845
US

IV. Provider business mailing address

8205 PENNSYLVANIA ST
DENVER CO
80229-5845
US

V. Phone/Fax

Practice location:
  • Phone: 720-427-7223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: VICTOR BANUELOS GANDARA
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 720-427-7223