Provider Demographics
NPI:1205409489
Name:EMMAS ANGELS LLC
Entity Type:Organization
Organization Name:EMMAS ANGELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAJADHAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:803-567-9572
Mailing Address - Street 1:1200 SAINT ANDREWS RD APT 2016
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5871
Mailing Address - Country:US
Mailing Address - Phone:803-567-9572
Mailing Address - Fax:
Practice Address - Street 1:1200 SAINT ANDREWS RD APT 2016
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5871
Practice Address - Country:US
Practice Address - Phone:803-567-9572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health