Provider Demographics
NPI:1255842647
Name:GRACE ANGELS HOME CARE CORP.
Entity Type:Organization
Organization Name:GRACE ANGELS HOME CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEDRICKIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-663-6211
Mailing Address - Street 1:1170 PEACHTREE ST NE STE 1200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-7673
Mailing Address - Country:US
Mailing Address - Phone:877-663-6211
Mailing Address - Fax:877-829-1388
Practice Address - Street 1:1170 PEACHTREE ST NE STE 1200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-7673
Practice Address - Country:US
Practice Address - Phone:877-663-6211
Practice Address - Fax:877-829-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health