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General NPI Number Information
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NPI Number | 1538406392
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Entity Type | Organization
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Legal Business Name | ANGELICA HOUSE LLC
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Dates
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Enumeration Date | 01/12/2013
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Last Update Date | 01/12/2013
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Provider Practice Location Address
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Address Line | 421 GLEN OAKS BLVD
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City | DALLAS
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State | TX
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Zip | 75232-2013
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Country | US
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Telephone | 972-748-1726
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Fax | 817-585-4806
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Provider Business Mailing Address
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Address Line | PO BOX 171817
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City | ARLINGTON
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State | TX
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Zip | 76003-1817
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Country | US
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Telephone | 972-748-1726
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Fax | 817-585-4806
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Authorized Official
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Title or Position | MANAGER
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Name | MR. ISRAEL MWESIGWA
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Credential |
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Telephone | 214-263-2389
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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 |
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License Number State |
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