Healthcare Provider Details

I. General information

NPI: 1871467837
Provider Name (Legal Business Name): COCO ANGEL OF HOPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 LEE RD APT 10210
LITHIA SPRINGS GA
30122-3094
US

IV. Provider business mailing address

1521 LEE RD APT 10210
LITHIA SPRINGS GA
30122-3094
US

V. Phone/Fax

Practice location:
  • Phone: 706-442-4438
  • Fax: 706-442-4438
Mailing address:
  • Phone: 706-442-4438
  • Fax: 706-442-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: YVONNE NYAMBI
Title or Position: ADMINISTRATOR
Credential:
Phone: 470-525-8509