Provider Demographics
NPI:1386519171
Name:BLUE ANGELS HOME CARE GEORGIA LLC
Entity type:Organization
Organization Name:BLUE ANGELS HOME CARE GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:FREHIWOT
Authorized Official - Middle Name:
Authorized Official - Last Name:DERSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-328-4341
Mailing Address - Street 1:1951 FERENTZ TRCE
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-3676
Mailing Address - Country:US
Mailing Address - Phone:770-328-4341
Mailing Address - Fax:678-495-1401
Practice Address - Street 1:1951 FERENTZ TRCE
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3676
Practice Address - Country:US
Practice Address - Phone:770-328-4341
Practice Address - Fax:678-495-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care