Provider Demographics
NPI:1063937589
Name:ANGEL CARE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:ANGEL CARE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:NOZAL
Authorized Official - Last Name:RUZANO
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF PHILOSOPHY
Authorized Official - Phone:872-888-5844
Mailing Address - Street 1:7644 W OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2830
Mailing Address - Country:US
Mailing Address - Phone:872-888-5844
Mailing Address - Fax:847-231-0224
Practice Address - Street 1:5875 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4672
Practice Address - Country:US
Practice Address - Phone:872-888-5844
Practice Address - Fax:847-231-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-05
Last Update Date:2017-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001120376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3001120OtherHOME CARE SERVICES