Healthcare Provider Details

I. General information

NPI: 1093960932
Provider Name (Legal Business Name): ANGEL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 OLD RIVER ST
HACKENSACK NJ
07601-7109
US

IV. Provider business mailing address

381 MAIN ST
HACKENSACK NJ
07601-5806
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-2818
  • Fax: 201-265-2817
Mailing address:
  • Phone: 201-265-2818
  • Fax: 201-265-2817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0115400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0184586
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MRS. TAMI C WEAVER
Title or Position: CEO/PRESIDENT
Credential:
Phone: 201-265-2818