Provider Demographics
NPI:1447593082
Name:GARDEN OF ANGELS LLC
Entity Type:Organization
Organization Name:GARDEN OF ANGELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-878-6945
Mailing Address - Street 1:4807 N STATE ST
Mailing Address - Street 2:STE 406
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-4826
Mailing Address - Country:US
Mailing Address - Phone:601-982-3555
Mailing Address - Fax:601-982-3557
Practice Address - Street 1:4807 N STATE ST
Practice Address - Street 2:STE 406
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4826
Practice Address - Country:US
Practice Address - Phone:601-982-3555
Practice Address - Fax:601-982-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care