Provider Demographics
NPI:1902226533
Name:ANGEL PRIVATE DUTY NURSING SERVICES LLC
Entity Type:Organization
Organization Name:ANGEL PRIVATE DUTY NURSING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-3785
Mailing Address - Street 1:200 GLASSCO ST
Mailing Address - Street 2:P.O. BOX 1681
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-4434
Mailing Address - Country:US
Mailing Address - Phone:662-843-3785
Mailing Address - Fax:662-843-3401
Practice Address - Street 1:200 GLASSCO ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-4434
Practice Address - Country:US
Practice Address - Phone:662-843-3785
Practice Address - Fax:662-843-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care