Provider Demographics
NPI:1053711556
Name:ANGEL ALLIANCE CAREGIVERS, LLC
Entity type:Organization
Organization Name:ANGEL ALLIANCE CAREGIVERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-965-0028
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:COLOGNE
Mailing Address - State:NJ
Mailing Address - Zip Code:08213-0242
Mailing Address - Country:US
Mailing Address - Phone:609-965-0028
Mailing Address - Fax:
Practice Address - Street 1:703 WEST WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08213
Practice Address - Country:US
Practice Address - Phone:609-965-0028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0159300253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care