Provider Demographics
NPI:1568802239
Name:ELITE CARE ANGELS INC
Entity Type:Organization
Organization Name:ELITE CARE ANGELS INC
Other - Org Name:E C A IN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BRATHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:4044628363
Authorized Official - Phone:404-462-8363
Mailing Address - Street 1:571 PENNYLAKE LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5769
Mailing Address - Country:US
Mailing Address - Phone:404-462-8363
Mailing Address - Fax:404-474-4784
Practice Address - Street 1:571 PENNYLAKE LN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5769
Practice Address - Country:US
Practice Address - Phone:404-462-8363
Practice Address - Fax:404-474-4784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN00300215233140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric