Provider Demographics
NPI:1962373795
Name:ANGELIC HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:ANGELIC HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KOBINA
Authorized Official - Middle Name:POKU
Authorized Official - Last Name:ODUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-359-1202
Mailing Address - Street 1:17325 ROCKY MOUNT LN
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-3302
Mailing Address - Country:US
Mailing Address - Phone:571-359-1202
Mailing Address - Fax:571-359-1202
Practice Address - Street 1:3177 BARBEQUE PL
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-8529
Practice Address - Country:US
Practice Address - Phone:703-962-8942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health