Provider Demographics
NPI:1629476650
Name:GOD'S MISSING ANGEL'S LLC
Entity Type:Organization
Organization Name:GOD'S MISSING ANGEL'S LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRELL
Authorized Official - Middle Name:LINNETTE
Authorized Official - Last Name:BAILY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-312-8633
Mailing Address - Street 1:301 CROFT XING
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-7006
Mailing Address - Country:US
Mailing Address - Phone:757-312-8633
Mailing Address - Fax:757-312-8633
Practice Address - Street 1:301 CROFT XING
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-7006
Practice Address - Country:US
Practice Address - Phone:757-312-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home