Provider Demographics
NPI:1336740356
Name:CHARLIES ANGELS CARE CORP
Entity Type:Organization
Organization Name:CHARLIES ANGELS CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRSYTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-299-8531
Mailing Address - Street 1:525 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TWIN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30471-4187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 W BROAD ST
Practice Address - Street 2:
Practice Address - City:TWIN CITY
Practice Address - State:GA
Practice Address - Zip Code:30471-4187
Practice Address - Country:US
Practice Address - Phone:478-299-8531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care