Organization
ANGELIQUE HEALTHCARE SUPPLY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSELYN JACK CFS (PRESIDENT)
(817) 299-0297
Entity
Organization
Contact information
Practice address
2535 E. ARKANSAS LN, SUITE 311, ARLINGTON, TX 76010-8797
(817) 299-0297
(817) 299-0394
Mailing address
2535 E. ARKANSAS LANE, SUITE 311, ARLINGTON, TX 76010-8797
(817) 299-0297
(817) 299-0394
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
0088916
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0088916
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0088916
TDSHS LICENSE
TX
05
—
185278201
—
TX
05
—
185278202
—
TX
05
—
185278203
—
TX
Enumeration date
09/20/2006
Last updated
07/15/2008
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