Healthcare Provider Details

I. General information

NPI: 1770784688
Provider Name (Legal Business Name): ANGELCITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 AIRWAYS BLVD SUITE 119
MEMPHIS TN
38116-3841
US

IV. Provider business mailing address

3385 AIRWAYS BLVD SUITE 119
MEMPHIS TN
38116-3841
US

V. Phone/Fax

Practice location:
  • Phone: 901-395-0199
  • Fax:
Mailing address:
  • Phone: 901-395-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5188562
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number5188562
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number5188562
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number5188562
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number5188562
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number5188562
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number1770784688
License Number StateTN
# 8
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5188562
License Number StateTN

VIII. Authorized Official

Name: MR. RALPH E MONROE
Title or Position: PRESIDENT & CEO
Credential: NONE
Phone: 901-395-0199