MEDICARE: ANGELIC HEALTHCARE NEW JERSEY 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1588496012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC HEALTHCARE NEW JERSEY INC.

Provider Business Mailing Address
First Line	:	906 OAK TREE AVE STE F
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-5133
Country	:	US
Telephone Number	:	908-843-5763
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 OAK TREE AVE STE F
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-5133
Country	:	US
Telephone Number	:	908-843-5763
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ZENITH YLANAN
Credential	:	RN
Telephone Number	:	908-801-3694

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	08/15/2024

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