Provider Demographics
NPI:1396322640
Name:ANGEL HEART HOSPICE AND PALLIATIVE CARE
Entity type:Organization
Organization Name:ANGEL HEART HOSPICE AND PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DWELVER
Authorized Official - Middle Name:NIKKI
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:CHAPLAIN
Authorized Official - Phone:470-381-2983
Mailing Address - Street 1:2302 PARKLAKE DR NE STE 568
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2896
Mailing Address - Country:US
Mailing Address - Phone:678-281-5106
Mailing Address - Fax:
Practice Address - Street 1:2302 PARKLAKE DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2896
Practice Address - Country:US
Practice Address - Phone:470-381-2983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based