Provider Demographics
NPI:1710336854
Name:GINA'S ANGELS HOME HEALTHCARE, LLC.
Entity Type:Organization
Organization Name:GINA'S ANGELS HOME HEALTHCARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-773-6936
Mailing Address - Street 1:3282 S BOWMAN RD
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-3684
Mailing Address - Country:US
Mailing Address - Phone:602-773-6936
Mailing Address - Fax:888-897-8710
Practice Address - Street 1:3282 S BOWMAN RD
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85119-3684
Practice Address - Country:US
Practice Address - Phone:602-773-6936
Practice Address - Fax:888-897-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033726OtherAHCCCS ALTCS