Provider Demographics
NPI:1821113226
Name:ANGELS WITH CARE AGENCY
Entity Type:Organization
Organization Name:ANGELS WITH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCTIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-366-8644
Mailing Address - Street 1:1781 DOC MCTIER RD
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513
Mailing Address - Country:US
Mailing Address - Phone:912-366-8644
Mailing Address - Fax:912-366-8645
Practice Address - Street 1:1781 DOC MCTIER RD.
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513
Practice Address - Country:US
Practice Address - Phone:912-366-8644
Practice Address - Fax:912-366-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001-R-0005251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000886201CMedicaid