Provider Demographics
NPI:1104162825
Name:ANGELIC HEALTHCARE LLC
Entity type:Organization
Organization Name:ANGELIC HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-428-7558
Mailing Address - Street 1:43 DOLSEN PL APT 2
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1106
Mailing Address - Country:US
Mailing Address - Phone:203-965-0811
Mailing Address - Fax:
Practice Address - Street 1:43 DOLSEN PLACE APT. 2
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901
Practice Address - Country:US
Practice Address - Phone:203-428-7558
Practice Address - Fax:203-965-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0000620251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health