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General NPI Number Information
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NPI Number | 1831955814
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Entity Type | Organization
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Legal Business Name | THE ANGEL HOUSE
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 10/19/2024
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Provider Practice Location Address
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Address Line | 5103 W 123RD PL
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City | HAWTHORNE
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State | CA
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Zip | 90250-3525
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Country | US
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Telephone | 562-896-3909
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Fax |
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Provider Business Mailing Address
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Address Line | 552 E CARSON ST STE 104
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City | CARSON
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State | CA
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Zip | 90745-2897
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Country | US
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Telephone | 562-896-3909
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. MICHELLE MARSHALL-CAIQUO
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Credential |
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Telephone | 562-405-7316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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