Provider Demographics
NPI:1003402322
Name:ANGELS OF GRACE, LLC
Entity Type:Organization
Organization Name:ANGELS OF GRACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EHIMEMEN
Authorized Official - Middle Name:OJEABULU
Authorized Official - Last Name:IBOAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-831-6380
Mailing Address - Street 1:104 JONES FERRY RD STE A
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2036
Mailing Address - Country:US
Mailing Address - Phone:919-968-3724
Mailing Address - Fax:919-551-8320
Practice Address - Street 1:104 JONES FERRY RD STE A
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2036
Practice Address - Country:US
Practice Address - Phone:919-968-3724
Practice Address - Fax:919-551-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care