Provider Demographics
NPI:1437621851
Name:ANGEL HOME HEALTHCARE
Entity Type:Organization
Organization Name:ANGEL HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-523-3592
Mailing Address - Street 1:867 COMMERCE DR SW STE 100
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6604
Mailing Address - Country:US
Mailing Address - Phone:770-544-7643
Mailing Address - Fax:770-679-4915
Practice Address - Street 1:867 COMMERCE DR SW STE 100
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6604
Practice Address - Country:US
Practice Address - Phone:770-544-7643
Practice Address - Fax:770-679-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1932344645OtherNPI