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General NPI Number Information
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NPI Number | 1013641174
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Entity Type | Organization
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Legal Business Name | DOMINIQUE ANGELS HOME CARE LLC
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 2200 CLOVER PARK DR
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City | ARLINGTON
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State | TX
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Zip | 76013-1434
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Country | US
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Telephone | 181-750-0387
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Fax | 817-200-6203
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Provider Business Mailing Address
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Address Line | 2200 CLOVER PARK DR
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City | ARLINGTON
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State | TX
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Zip | 76013-1434
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Country | US
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Telephone | 817-500-3873
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Fax | 817-200-6203
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Authorized Official
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Title or Position | MANGER/HOME HEALTH AIDE
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Name | ANTIONETTE L RAVENELL
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Credential | HOME HEALTH AIDE
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Telephone | 817-500-3873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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