Angel Adhc, Inc

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

ANGEL ADHC, INC

Doing business as

Angel Adult Day Health Care

Practice address

1417 W Washington Blvd
Los Angeles, CA 90007-1236

Phone

(213) 745-4290

Fax

(213) 745-4297

NPI assigned

May 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Koom Soun Son, RN

Title

Owner

Phone

(213) 745-4290

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ANGEL ADULT DAY HEALTH CARE Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184831752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 W WASHINGTON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900071236",
            "telephone_number": "213-745-4290",
            "fax_number": "213-745-4297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 W WASHINGTON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900071236",
            "telephone_number": "213-745-4290",
            "fax_number": "213-745-4297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL ADHC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SON",
        "authorized_official_first_name": "KOOM",
        "authorized_official_middle_name": "SOUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "213-745-4290",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ADU70268F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ANGEL ADULT DAY HEALTH CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Day Care Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Adult Day Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.