Organization
ANGEL'S HOME ICF, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY R ANGEL PA-C (PRESIDENT / ADMINISTRATOR)
(510) 289-3848
Entity
Organization
Contact information
Practice address
10712 WATERBURY DR, STOCKTON, CA 95209-4212
(510) 289-3848
(209) 477-1449
Mailing address
10712 WATERBURY DR, STOCKTON, CA 95209-4212
(510) 289-3848
(209) 477-1449
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
CA
Other
Enumeration date
12/23/2014
Last updated
12/23/2014
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