Provider Demographics
NPI:1023599172
Name:ANGEL'S LOV, INC
Entity type:Organization
Organization Name:ANGEL'S LOV, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE AND ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-249-0464
Mailing Address - Street 1:330 UNION ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3659
Mailing Address - Country:US
Mailing Address - Phone:931-494-8720
Mailing Address - Fax:
Practice Address - Street 1:330 UNION ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3659
Practice Address - Country:US
Practice Address - Phone:931-494-8720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10000000227843747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ038061Medicaid