Healthcare Provider Details

I. General information

NPI: 1629476650
Provider Name (Legal Business Name): GOD'S MISSING ANGEL'S LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CROFT XING
CHESAPEAKE VA
23320-7006
US

IV. Provider business mailing address

301 CROFT XING
CHESAPEAKE VA
23320-7006
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-8633
  • Fax:
Mailing address:
  • Phone: 757-312-8633
  • Fax: 757-312-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. SHERRELL LINNETTE BAILY
Title or Position: OWNER
Credential: RN
Phone: 757-312-8633