Provider Demographics
NPI:1649167032
Name:ANGELS DOME HOME HEALTHCARE INC
Entity type:Organization
Organization Name:ANGELS DOME HOME HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELECHI
Authorized Official - Middle Name:O
Authorized Official - Last Name:BASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-349-2718
Mailing Address - Street 1:8386 SIX FORKS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5088
Mailing Address - Country:US
Mailing Address - Phone:872-235-7194
Mailing Address - Fax:
Practice Address - Street 1:211 S JARVIS ST STE 104
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-2052
Practice Address - Country:US
Practice Address - Phone:919-349-2718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care