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General NPI Number Information
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NPI Number | 1568171783
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Entity Type | Organization
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Legal Business Name | AN ANGEL GARDEN INC
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 9873 TRAVELER CT
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City | ELK GROVE
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State | CA
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Zip | 95624-4724
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Country | US
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Telephone | 530-886-9529
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Fax | 916-775-7731
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Provider Business Mailing Address
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Address Line | 9873 TRAVELER CT
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City | ELK GROVE
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State | CA
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Zip | 95624-4724
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Country | US
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Telephone | 530-886-9529
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Fax | 916-775-7731
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Authorized Official
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Title or Position | OWNWER/ADMINISTRATOR
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Name | MS. YOUNGSUK CHO
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Credential | RN
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Telephone | 530-886-9529
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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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