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General NPI Number Information
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NPI Number | 1205224334
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Entity Type | Organization
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Legal Business Name | ANGEL'S HOME ICF, INC.
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Dates
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Enumeration Date | 12/23/2014
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 10712 WATERBURY DR
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City | STOCKTON
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State | CA
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Zip | 95209-4212
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Country | US
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Telephone | 510-289-3848
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Fax | 209-477-1449
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Provider Business Mailing Address
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Address Line | 10712 WATERBURY DR
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City | STOCKTON
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State | CA
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Zip | 95209-4212
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Country | US
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Telephone | 510-289-3848
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Fax | 209-477-1449
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Authorized Official
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Title or Position | PRESIDENT / ADMINISTRATOR
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Name | MR. LARRY R ANGEL
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Credential | PA-C
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Telephone | 510-289-3848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | CA
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