Healthcare Provider Details

I. General information

NPI: 1922057652
Provider Name (Legal Business Name): ANGELICAL HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 LAKE POINT ST
LA JOYA TX
78560-4021
US

IV. Provider business mailing address

504 LAKE POINT ST
LA JOYA TX
78560-4021
US

V. Phone/Fax

Practice location:
  • Phone: 956-581-1251
  • Fax: 956-581-4859
Mailing address:
  • Phone: 956-581-1251
  • Fax: 956-581-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010100
License Number StateTX

VIII. Authorized Official

Name: MS. BLANCA LAMAR GONZALEZ
Title or Position: CFO/OWNER
Credential: R.N./CFO/OWNER
Phone: 956-581-1251