Healthcare Provider Details

I. General information

NPI: 1184721391
Provider Name (Legal Business Name): ANGELIQUE HEALTHCARE SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 E. ARKANSAS LN SUITE 311
ARLINGTON TX
76010-8797
US

IV. Provider business mailing address

2535 E. ARKANSAS LANE SUITE 311
ARLINGTON TX
76010-8797
US

V. Phone/Fax

Practice location:
  • Phone: 817-299-0297
  • Fax: 817-299-0394
Mailing address:
  • Phone: 817-299-0297
  • Fax: 817-299-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0088916
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0088916
License Number StateTX

VIII. Authorized Official

Name: MRS. ROSELYN JACK
Title or Position: PRESIDENT
Credential: CFS
Phone: 817-299-0297