Provider Demographics
NPI:1164664678
Name:ANGEL'S HOME HEALTH CARE
Entity Type:Organization
Organization Name:ANGEL'S HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:TALLEY
Authorized Official - Middle Name:LATISKA
Authorized Official - Last Name:PERINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-988-8751
Mailing Address - Street 1:102 JUPITER LN
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005
Mailing Address - Country:US
Mailing Address - Phone:478-988-8751
Mailing Address - Fax:478-218-2306
Practice Address - Street 1:102 JUPITER LN
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3338
Practice Address - Country:US
Practice Address - Phone:478-988-8751
Practice Address - Fax:478-218-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028845934253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care