Healthcare Provider Details

I. General information

NPI: 1992482152
Provider Name (Legal Business Name): ANGELIC HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 CRAWFORD FARMS DR
FORT WORTH TX
76244-6630
US

IV. Provider business mailing address

10000 CRAWFORD FARMS DR
FORT WORTH TX
76244-6630
US

V. Phone/Fax

Practice location:
  • Phone: 817-500-5541
  • Fax:
Mailing address:
  • Phone: 817-500-5541
  • 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
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: OTTO RODAS
Title or Position: PRESIDENT/ADMIN/DON
Credential:
Phone: 817-500-5541