Healthcare Provider Details

I. General information

NPI: 1457159147
Provider Name (Legal Business Name): ANGELIC ANGELS HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 FALL AVE
KOOSKIA ID
83539
US

IV. Provider business mailing address

713 FALL AVE
KOOSKIA ID
83539
US

V. Phone/Fax

Practice location:
  • Phone: 208-451-1327
  • Fax:
Mailing address:
  • Phone: 208-451-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State

VIII. Authorized Official

Name: KRISTY R STAMPER
Title or Position: CEO
Credential: MBA, BS
Phone: 208-451-1327