Provider Demographics
NPI:1639701352
Name:ANGELS LIVE HERE INC.
Entity Type:Organization
Organization Name:ANGELS LIVE HERE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUSOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAIWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-557-7836
Mailing Address - Street 1:89 LEVEL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1779
Mailing Address - Country:US
Mailing Address - Phone:678-557-7836
Mailing Address - Fax:
Practice Address - Street 1:89 LEVEL CREEK RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1779
Practice Address - Country:US
Practice Address - Phone:678-557-7836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility