=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013579788
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELIC NURSING & HOME CARE REGISTRY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2019
-----------------------------------------------------
Last Update Date | 07/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 E CENTER ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06040-5201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-647-1956
-----------------------------------------------------
Fax | 860-533-0534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 65 E CENTER ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06040-5201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-647-1956
-----------------------------------------------------
Fax | 860-533-0534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. STACEY LYN LAPLANTE
-----------------------------------------------------
Credential | SENIOR ADVISOR
-----------------------------------------------------
Telephone | 860-647-1956
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------