Provider Demographics
NPI:1538406392
Name:ANGELICA HOUSE LLC
Entity type:Organization
Organization Name:ANGELICA HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MWESIGWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-263-2389
Mailing Address - Street 1:PO BOX 171817
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-1817
Mailing Address - Country:US
Mailing Address - Phone:972-748-1726
Mailing Address - Fax:817-585-4806
Practice Address - Street 1:421 GLEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-2013
Practice Address - Country:US
Practice Address - Phone:972-748-1726
Practice Address - Fax:817-585-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility