Provider Demographics
NPI:1487472734
Name:ANGELIC COMPANIONSHIP SERVICES, LLC
Entity type:Organization
Organization Name:ANGELIC COMPANIONSHIP SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:KAKILA
Authorized Official - Middle Name:SHERRIE
Authorized Official - Last Name:TAYLOR-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-403-2653
Mailing Address - Street 1:11201 N TATUM BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6039
Mailing Address - Country:US
Mailing Address - Phone:276-403-2653
Mailing Address - Fax:
Practice Address - Street 1:827 SMITH STR
Practice Address - Street 2:
Practice Address - City:MATTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-403-2653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty