Basic Information
| Provider Information | |||||||||
| NPI: | 1003842451 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANGELS PHH CORP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | ANGELS OF CARE PEDIATRIC HOME HEALTH OF TEXAS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 338 | ||||||||
| Address2: | |||||||||
| City: | HOWE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035321400 | ||||||||
| FaxNumber: | 9035321401 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 S COLLINS FRWY | ||||||||
| Address2: | |||||||||
| City: | HOWE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035321400 | ||||||||
| FaxNumber: | 9035321401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WEST | ||||||||
| AuthorizedOfficialFirstName: | BONNIE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9035321400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LVN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 008758 | TX | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 60P8877 | 01 | TX | MDCP UCN NUMBER | OTHER |