Provider Demographics
NPI:1497365340
Name:HEART OF AN ANGEL NURSING SOLUTIONS, LLC
Entity Type:Organization
Organization Name:HEART OF AN ANGEL NURSING SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:QUATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:470-914-9457
Mailing Address - Street 1:PO BOX 80536
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-8536
Mailing Address - Country:US
Mailing Address - Phone:470-914-9457
Mailing Address - Fax:
Practice Address - Street 1:612 KESWICK VILLAGE CT NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6523
Practice Address - Country:US
Practice Address - Phone:678-800-5091
Practice Address - Fax:678-609-0592
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEART OF AN ANGEL NURSING SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-05
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty