Provider Demographics
NPI:1962173898
Name:ANGEL CARE PCPS CORP
Entity type:Organization
Organization Name:ANGEL CARE PCPS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDUALEM
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKNEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-771-1589
Mailing Address - Street 1:1010 S JOLIET ST STE 106
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3150
Mailing Address - Country:US
Mailing Address - Phone:702-771-1589
Mailing Address - Fax:720-532-0249
Practice Address - Street 1:1010 S JOLIET ST STE 106
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3150
Practice Address - Country:US
Practice Address - Phone:702-771-1589
Practice Address - Fax:720-532-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health