Provider Demographics
NPI:1376321430
Name:4ANGELS OF BYROMVILLE HEALTHCARE CENTER
Entity Type:Organization
Organization Name:4ANGELS OF BYROMVILLE HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SLEGNA
Authorized Official - Middle Name:HEALTHCARE
Authorized Official - Last Name:CONSULTANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-349-4507
Mailing Address - Street 1:4922 BILL GARDNER PKWY # 280
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:BYROMVILLE
Practice Address - State:GA
Practice Address - Zip Code:31007-3760
Practice Address - Country:US
Practice Address - Phone:470-349-4507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care