Provider Demographics
NPI:1871766139
Name:ANGEL CARE P.C.A. SVCS., INC.
Entity type:Organization
Organization Name:ANGEL CARE P.C.A. SVCS., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:504-450-6835
Mailing Address - Street 1:152 W MAIN ST STE B-5
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3871
Mailing Address - Country:US
Mailing Address - Phone:337-376-6150
Mailing Address - Fax:337-256-8968
Practice Address - Street 1:119 VINE ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3638
Practice Address - Country:US
Practice Address - Phone:504-450-6835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20048302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization