MEDICARE: AN ANGEL GARDEN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1568171783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AN ANGEL GARDEN INC

Provider Business Mailing Address
First Line	:	9873 TRAVELER CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-4724
Country	:	US
Telephone Number	:	530-886-9529
Fax Number	:	207-776-7233

Provider Business Practice Location Address
First Line	:	9873 TRAVELER CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-4724
Country	:	US
Telephone Number	:	530-886-9529
Fax Number	:	916-775-7731

Authorized Official
Title or Position	:	OWNWER/ADMINISTRATOR
Name	:	MS. YOUNGSUK CHO
Credential	:	RN
Telephone Number	:	530-886-9529

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	06/08/2026

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Directions to “AN ANGEL GARDEN INC ” Practice Location

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