1760699144 NPI number — ARCHANGEL HOME HEALTH, INC.

Table of content: (NPI 1760699144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760699144 NPI number — ARCHANGEL HOME HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCHANGEL HOME HEALTH, 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:
1760699144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16446 WOODRUFF AVE STE A
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BELLFLOWER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90706-4975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-861-7047
Provider Business Mailing Address Fax Number:
562-861-7069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16446 WOODRUFF AVE STE A
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BELLFLOWER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90706-4975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-861-7047
Provider Business Practice Location Address Fax Number:
562-861-7069
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUH
Authorized Official First Name:
KYUNG (DANIEL)
Authorized Official Middle Name:
SIK
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
562-861-7047

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  550000586 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 550000586 . This is a "CDPH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760699144 . This is a "MEDI-CAL PROV#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com