Provider Demographics
NPI: | 1851610943 |
---|---|
Name: | GLORIA'S ANGELS HOME HEALTH CARE |
Entity Type: | Organization |
Organization Name: | GLORIA'S ANGELS HOME HEALTH CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | JEWEL |
Authorized Official - Middle Name: | LYNETTE |
Authorized Official - Last Name: | BAILEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 757-673-4407 |
Mailing Address - Street 1: | 3300 HIGH ST |
Mailing Address - Street 2: | SUITE 2 |
Mailing Address - City: | PORTSMOUTH |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23707-3321 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-673-4407 |
Mailing Address - Fax: | 757-673-4432 |
Practice Address - Street 1: | 3300 HIGH ST |
Practice Address - Street 2: | SUITE 2 |
Practice Address - City: | PORTSMOUTH |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23707-3321 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-673-4407 |
Practice Address - Fax: | 757-673-4432 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-05-27 |
Last Update Date: | 2012-08-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health | |
No | 251B00000X | Agencies | Case Management | |
No | 253Z00000X | Agencies | In Home Supportive Care |