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General NPI Number Information
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NPI Number | 1043505175
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Entity Type | Organization
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Legal Business Name | ANGELS HAVEN, LLC
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 2724 CALICO ROCK DR
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City | FORT WORTH
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State | TX
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Zip | 76131-2034
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Country | US
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Telephone | 817-262-0333
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Fax | 817-386-2929
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Provider Business Mailing Address
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Address Line | 4956 OBRIEN WAY
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City | FORT WORTH
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State | TX
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Zip | 76244-6142
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Country | US
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Telephone | 817-262-0333
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Fax | 817-386-2929
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Authorized Official
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Title or Position | MANAGING MEMBER / PRESIDENT
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Name | MS. TRANG T CARR
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Credential |
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Telephone | 817-262-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 132136
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License Number State | TX
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