Provider Demographics
NPI:1801224647
Name:GIFTED ANGELS IN HOME AIDE CARE
Entity Type:Organization
Organization Name:GIFTED ANGELS IN HOME AIDE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA 1
Authorized Official - Prefix:
Authorized Official - First Name:NARINA
Authorized Official - Middle Name:ODESSA
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:CNA 1
Authorized Official - Phone:704-598-6603
Mailing Address - Street 1:8647 EARTHENWARE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7353
Mailing Address - Country:US
Mailing Address - Phone:704-598-6603
Mailing Address - Fax:
Practice Address - Street 1:8647 EARTHENWARE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7353
Practice Address - Country:US
Practice Address - Phone:704-598-6603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC413145251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC413145OtherNORTH CAROLINA REGISTRY