Provider Demographics
NPI:1255664306
Name:RA HOME ANGELS CORP
Entity Type:Organization
Organization Name:RA HOME ANGELS CORP
Other - Org Name:RENAISSANCE CARE OF THE SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RASA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRIPEIKIS
Authorized Official - Suffix:
Authorized Official - Credentials:PMP
Authorized Official - Phone:770-409-1455
Mailing Address - Street 1:4496 E JONES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1617
Mailing Address - Country:US
Mailing Address - Phone:770-409-1455
Mailing Address - Fax:
Practice Address - Street 1:4496 E JONES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1617
Practice Address - Country:US
Practice Address - Phone:770-409-1455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-0596253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care