Healthcare Provider Details

I. General information

NPI: 1912778705
Provider Name (Legal Business Name): ANGEL CARE AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 NW 72ND ST # 212F
WARR ACRES OK
73132-5931
US

IV. Provider business mailing address

5601 NW 72ND ST # 212F
WARR ACRES OK
73132-5931
US

V. Phone/Fax

Practice location:
  • Phone: 405-367-7113
  • Fax:
Mailing address:
  • Phone: 405-367-7113
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VICTORY NJINDANGAM
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 405-410-1438