1063937589 NPI number — ANGEL CARE HEALTH SERVICES, INC.

Table of content: (NPI 1063937589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063937589 NPI number — ANGEL CARE HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGEL CARE HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063937589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7644 W OAKTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NILES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60714-2830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
872-888-5844
Provider Business Mailing Address Fax Number:
847-231-0224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5875 N LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60659-4672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
872-888-5844
Provider Business Practice Location Address Fax Number:
847-231-0224
Provider Enumeration Date:
08/05/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUZANO
Authorized Official First Name:
ALONZO
Authorized Official Middle Name:
NOZAL
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
872-888-5844

Provider Taxonomy Codes

  • Taxonomy code: 376J00000X , with the licence number:  3001120 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3001120 . This is a "HOME CARE SERVICES" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".