Healthcare Provider Details

I. General information

NPI: 1609589654
Provider Name (Legal Business Name): ARCHANGEL HOME HEALTH AND PRIMARY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 WOLFE ST
CEDAR HILL TX
75104-5126
US

IV. Provider business mailing address

204 WOLFE ST
CEDAR HILL TX
75104-5126
US

V. Phone/Fax

Practice location:
  • Phone: 817-441-3614
  • Fax:
Mailing address:
  • Phone: 817-441-3614
  • 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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: IRENE C YANKEY
Title or Position: OWNER
Credential: RN
Phone: 174-441-3614