Healthcare Provider Details

I. General information

NPI: 1356908214
Provider Name (Legal Business Name): ANGELS ON YOUR SIDE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 E BROADWAY ST
FORREST CITY AR
72335-7881
US

IV. Provider business mailing address

PO BOX 462
FORREST CITY AR
72336-0462
US

V. Phone/Fax

Practice location:
  • Phone: 870-455-3004
  • Fax:
Mailing address:
  • Phone: 870-455-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TAIMEKA HAGGANS
Title or Position: CEO
Credential:
Phone: 870-455-3004