Provider Demographics
NPI:1093910168
Name:ANGELIC PERSONAL CARE SERVICES, LLC
Entity type:Organization
Organization Name:ANGELIC PERSONAL CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:VALENTINE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-644-2326
Mailing Address - Street 1:14046 AIRLINE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737
Mailing Address - Country:US
Mailing Address - Phone:225-644-2326
Mailing Address - Fax:225-647-4754
Practice Address - Street 1:14046 AIRLINE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-644-2326
Practice Address - Fax:225-647-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9121251C00000X
251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1172308OtherPERSONAL CARE ATTENDANT
LA1145165OtherSUPERVISE INDEP. LIVING
LA1126187OtherELDERLY DISABLED ADULTS