Provider Demographics
NPI:1316195712
Name:ARKANGELS HOMECARE SERVICES
Entity Type:Organization
Organization Name:ARKANGELS HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BENEDETEH
Authorized Official - Middle Name:U
Authorized Official - Last Name:MOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-477-4755
Mailing Address - Street 1:9411 S MAIN ST
Mailing Address - Street 2:STE-D
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-8705
Mailing Address - Country:US
Mailing Address - Phone:770-477-4755
Mailing Address - Fax:770-477-4758
Practice Address - Street 1:9411 S MAIN ST
Practice Address - Street 2:STE-D
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-8705
Practice Address - Country:US
Practice Address - Phone:770-477-4755
Practice Address - Fax:770-477-4758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARKANGELS HOMECARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031 R 0040332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA457729570DMedicaid
GA1316195712Medicare PIN
GA457729570DMedicaid