Provider Demographics
NPI:1174356869
Name:ANGEL HEALTHCARE NURSING
Entity type:Organization
Organization Name:ANGEL HEALTHCARE NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDIDIONG
Authorized Official - Middle Name:
Authorized Official - Last Name:UBOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-599-4860
Mailing Address - Street 1:4920 NIAGARA RD STE 318
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1157
Mailing Address - Country:US
Mailing Address - Phone:240-599-4860
Mailing Address - Fax:240-599-4861
Practice Address - Street 1:4920 NIAGARA RD STE 318
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1157
Practice Address - Country:US
Practice Address - Phone:240-599-4860
Practice Address - Fax:240-599-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health