Provider Demographics
NPI:1558727891
Name:ANGELITE HOMECARE CENTER, LLC
Entity Type:Organization
Organization Name:ANGELITE HOMECARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ NURSE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-464-7284
Mailing Address - Street 1:8491 HOSPITAL DR
Mailing Address - Street 2:176
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2412
Mailing Address - Country:US
Mailing Address - Phone:678-486-3841
Mailing Address - Fax:770-703-1553
Practice Address - Street 1:1524 N MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-2284
Practice Address - Country:US
Practice Address - Phone:706-621-7331
Practice Address - Fax:877-866-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 251J00000X
GA129-R-1496253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care