Provider Demographics
NPI:1205192044
Name:ANGELS HEARTS HOME CARE
Entity Type:Organization
Organization Name:ANGELS HEARTS HOME CARE
Other - Org Name:ANGELS HEARTS HOME CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-364-2033
Mailing Address - Street 1:2035 WOODDALE BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1517
Mailing Address - Country:US
Mailing Address - Phone:225-364-2033
Mailing Address - Fax:225-364-2190
Practice Address - Street 1:120 VICKIE ST
Practice Address - Street 2:
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390-8638
Practice Address - Country:US
Practice Address - Phone:225-717-2598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203781016253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2176421Medicaid