Provider Demographics
NPI:1245003037
Name:ANGELES CARE HOME LLC
Entity type:Organization
Organization Name:ANGELES CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:PINGUL
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-382-3850
Mailing Address - Street 1:955 HANAU ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-4826
Mailing Address - Country:US
Mailing Address - Phone:808-382-3850
Mailing Address - Fax:
Practice Address - Street 1:955 HANAU ST
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-4826
Practice Address - Country:US
Practice Address - Phone:808-382-3850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency