Provider Demographics
NPI:1629441852
Name:COMFORTING ANGELS HOME CARE SERVICE
Entity Type:Organization
Organization Name:COMFORTING ANGELS HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:CELESTINE
Authorized Official - Last Name:HULBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-497-9177
Mailing Address - Street 1:5395 FOX PLAZA DR STE 108
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-1580
Mailing Address - Country:US
Mailing Address - Phone:901-421-5127
Mailing Address - Fax:
Practice Address - Street 1:5395 FOX PLAZA DR STE 108
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1580
Practice Address - Country:US
Practice Address - Phone:901-421-5127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445831Medicaid