Provider Demographics
NPI:1750719860
Name:ANGEL HEART HOMECARE AND HOSPICE, INC
Entity type:Organization
Organization Name:ANGEL HEART HOMECARE AND HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-549-3160
Mailing Address - Street 1:3224 WASHINGTON RD
Mailing Address - Street 2:STE B
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5421
Mailing Address - Country:US
Mailing Address - Phone:404-549-3160
Mailing Address - Fax:404-763-4115
Practice Address - Street 1:3224 WASHINGTON RD
Practice Address - Street 2:STE B
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5421
Practice Address - Country:US
Practice Address - Phone:404-549-3160
Practice Address - Fax:404-763-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based