Provider Demographics
NPI:1215627559
Name:ARCHANGEL HOME CARE
Entity type:Organization
Organization Name:ARCHANGEL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-446-0516
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29597-0064
Mailing Address - Country:US
Mailing Address - Phone:843-446-0516
Mailing Address - Fax:
Practice Address - Street 1:1000 SEA MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2211
Practice Address - Country:US
Practice Address - Phone:843-446-0516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care