Provider Demographics
NPI:1780117911
Name:ANGELLICARE INC.
Entity type:Organization
Organization Name:ANGELLICARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-714-2273
Mailing Address - Street 1:17325 EUCLID AVE
Mailing Address - Street 2:SUITE 2060
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1247
Mailing Address - Country:US
Mailing Address - Phone:216-714-2273
Mailing Address - Fax:216-485-2909
Practice Address - Street 1:17325 EUCLID AVE
Practice Address - Street 2:SUITE 2060
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1247
Practice Address - Country:US
Practice Address - Phone:216-714-2273
Practice Address - Fax:216-485-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0209173Medicaid