Provider Demographics
NPI:1376829473
Name:ANGEL HEART HOMECARE & HOSPICE
Entity Type:Organization
Organization Name:ANGEL HEART HOMECARE & HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:770-873-3185
Mailing Address - Street 1:18 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31816-2113
Mailing Address - Country:US
Mailing Address - Phone:904-303-5535
Mailing Address - Fax:404-763-4115
Practice Address - Street 1:18 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:GA
Practice Address - Zip Code:31816-2113
Practice Address - Country:US
Practice Address - Phone:904-303-5535
Practice Address - Fax:404-763-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251G00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care