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ANGEL'S HOME ICF, INC.
NPI 1205224334
Nursing Facility/Intermediate Care Facility in Stockton, CA

Active since December 23, 2014CLIA 05D2101819 · Waiver
10712 WATERBURY DR, STOCKTON, CA 95209(510) 289-3848(209) 477-1449 Get Directions Write a Review

NPPES record last updated: December 23, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Angel's Home Icf, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANGEL'S HOME ICF, INC. (NPI 1205224334) is a healthcare organization registered as a nursing facility/intermediate care facility in Stockton, California and active in the NPI registry since December 2014. The organization holds a CLIA Waiver certificate valid through September 9, 2027 and lists Larry R Angel, President / Administrator, as its authorized official.

NPPES Registry Identity

NPI1205224334
Entity TypeOrganization
Primary Taxonomy313M00000X
Legal Business NameANGEL'S HOME ICF, INC.
Location Address10712 WATERBURY DRStockton, CA 95209-4212
Mailing Address10712 Waterbury DrStockton, CA 95209-4212 · (510) 289-3848 · Fax (209) 477-1449
Phone(510) 289-3848
Fax(209) 477-1449
Organization SubpartNo
Authorized OfficialLarry R AngelPresident / Administrator · (510) 289-3848
Enumeration DateDecember 23, 2014
✔ NPI 1205224334 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities
Taxonomy Code313M00000X
Definition
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.
10712 WATERBURY DR, Stockton, CA 95209
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2101819

Angel's Home Icf, Inc. · Stockton, CA
Active · expires Sep 9, 2027
CLIA Number05D2101819
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateSeptember 10, 2025
Certificate Expiration DateSeptember 9, 2027
Laboratory DirectorAziz Kamali, MD
Laboratory Phone(209) 851-8842
Laboratory LocationAngel's Home Icf, Inc.10712 Waterbury Dr, Stockton, CA 95209
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Angel's Home Icf, Inc.'s NPI number?

The NPI number for Angel's Home Icf, Inc. is 1205224334. It was assigned to this organization in the NPPES registry on December 23, 2014.

Where is Angel's Home Icf, Inc. located?

Angel's Home Icf, Inc. is located at 10712 Waterbury Dr, Stockton, CA 95209. The listed phone number is (510) 289-3848.

What is Angel's Home Icf, Inc.'s specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

Does Angel's Home Icf, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2101819) is associated with this NPI, valid through September 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Angel's Home Icf, Inc. was last updated on December 23, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.