Provider Demographics
NPI:1063957199
Name:ANGELIC TOUCH CONCIERGE NURSING LLC
Entity type:Organization
Organization Name:ANGELIC TOUCH CONCIERGE NURSING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEMETRIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-937-9569
Mailing Address - Street 1:144 BUSINESS PARK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6527
Mailing Address - Country:US
Mailing Address - Phone:757-937-9569
Mailing Address - Fax:757-937-5970
Practice Address - Street 1:144 BUSINESS PARK DR STE 202
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6527
Practice Address - Country:US
Practice Address - Phone:757-937-9569
Practice Address - Fax:757-937-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care