Healthcare Provider Details

I. General information

NPI: 1891618153
Provider Name (Legal Business Name): ANGELUS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 OPAL ST
ELMONT NY
11003-4309
US

IV. Provider business mailing address

167 OPAL ST
ELMONT NY
11003-4309
US

V. Phone/Fax

Practice location:
  • Phone: 917-755-6697
  • Fax:
Mailing address:
  • Phone: 917-755-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TONYA OLADIRAN
Title or Position: ADMINISTRATOR
Credential: MHA, MBA, LNHA
Phone: 917-755-6697