Provider Demographics
NPI:1184278087
Name:HOLISTIC ANGELS PROVIDER SERVICES COMPANY
Entity type:Organization
Organization Name:HOLISTIC ANGELS PROVIDER SERVICES COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:404-317-7270
Mailing Address - Street 1:3011 RAINBOW DR STE 303
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1867
Mailing Address - Country:US
Mailing Address - Phone:678-773-0291
Mailing Address - Fax:
Practice Address - Street 1:3011 RAINBOW DR STE 303
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1867
Practice Address - Country:US
Practice Address - Phone:678-773-0291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA010350OtherGEORGIA DEPT OF COMMUNITY HEALTH