Provider Demographics
NPI:1356908214
Name:ANGELS ON YOUR SIDE HOME CARE
Entity type:Organization
Organization Name:ANGELS ON YOUR SIDE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAIMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGGANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-455-3004
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-0462
Mailing Address - Country:US
Mailing Address - Phone:870-455-3004
Mailing Address - Fax:
Practice Address - Street 1:2022 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7881
Practice Address - Country:US
Practice Address - Phone:870-455-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR232714732Medicaid
AR265101757Medicaid
AR232898797Medicaid
AR273118767Medicaid