Healthcare Provider Details

I. General information

NPI: 1649860321
Provider Name (Legal Business Name): A ANGELIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 NATCHEZ LN
GLENN HEIGHTS TX
75154-8938
US

IV. Provider business mailing address

607 NATCHEZ LN
GLENN HEIGHTS TX
75154-8938
US

V. Phone/Fax

Practice location:
  • Phone: 214-518-2055
  • Fax: 469-917-7691
Mailing address:
  • Phone: 214-518-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: KEISHA LAGAIL MANAHAN
Title or Position: CEO
Credential:
Phone: 214-518-2055