Healthcare Provider Details

I. General information

NPI: 1043774029
Provider Name (Legal Business Name): ANGEL NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16400 SOUTHCENTER PKWY STE 208
TUKWILA WA
98188-3383
US

IV. Provider business mailing address

16400 SOUTHCENTER PKWY STE 208
TUKWILA WA
98188-3383
US

V. Phone/Fax

Practice location:
  • Phone: 425-282-5505
  • Fax: 425-282-5324
Mailing address:
  • Phone: 425-282-5550
  • Fax: 425-282-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: SOPHIA MOIKOBU
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 425-282-5505