Provider Demographics
NPI:1760690077
Name:ANGEL GROVE INVESTMENTS LLC
Entity type:Organization
Organization Name:ANGEL GROVE INVESTMENTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-965-7267
Mailing Address - Street 1:303 ARBORS CIR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-5616
Mailing Address - Country:US
Mailing Address - Phone:512-965-7267
Mailing Address - Fax:512-285-9838
Practice Address - Street 1:303 ARBORS CIR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-5616
Practice Address - Country:US
Practice Address - Phone:512-965-7267
Practice Address - Fax:512-285-9838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies