Healthcare Provider Details

I. General information

NPI: 1447052949
Provider Name (Legal Business Name): ILLIANAS ANGEL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 ARBOR CREST LN
MANVEL TX
77578-5256
US

IV. Provider business mailing address

4419 ARBOR CREST LN
MANVEL TX
77578-5256
US

V. Phone/Fax

Practice location:
  • Phone: 956-867-8669
  • Fax:
Mailing address:
  • Phone: 956-867-8669
  • 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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DERDINE LAPAIX-FONTIL
Title or Position: ADMINISTRATOR
Credential:
Phone: 956-867-8669