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General NPI Number Information
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NPI Number | 1750107868
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Entity Type | Organization
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Legal Business Name | ANGELIC HOME CARE LLC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 3029 N MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06704-1214
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Country | US
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Telephone | 203-982-3834
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Fax |
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Provider Business Mailing Address
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Address Line | 85 PHYLLIS AVE
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City | WATERBURY
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State | CT
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Zip | 06708-3613
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Country | US
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Telephone | 203-982-3834
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Fax |
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Authorized Official
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Title or Position | CEO/CO-OWNER
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Name | DR. CHARLES J. O. KODI
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Credential | DR
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Telephone | 203-982-3834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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