Provider Demographics
NPI:1457159147
Name:ANGELIC ANGELS HOME CARE, LLC
Entity type:Organization
Organization Name:ANGELIC ANGELS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STAMPER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, BS
Authorized Official - Phone:208-451-1327
Mailing Address - Street 1:713 FALL AVE
Mailing Address - Street 2:
Mailing Address - City:KOOSKIA
Mailing Address - State:ID
Mailing Address - Zip Code:83539
Mailing Address - Country:US
Mailing Address - Phone:208-451-1327
Mailing Address - Fax:
Practice Address - Street 1:713 FALL AVE
Practice Address - Street 2:
Practice Address - City:KOOSKIA
Practice Address - State:ID
Practice Address - Zip Code:83539
Practice Address - Country:US
Practice Address - Phone:208-451-1327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health