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General NPI Number Information
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NPI Number | 1437621851
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Entity Type | Organization
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Legal Business Name | ANGEL HOME HEALTHCARE
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Dates
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Enumeration Date | 12/24/2018
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Last Update Date | 12/24/2018
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Provider Practice Location Address
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Address Line | 867 COMMERCE DR SW STE 100
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City | CONYERS
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State | GA
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Zip | 30094-6604
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Country | US
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Telephone | 770-544-7643
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Fax | 770-679-4915
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Provider Business Mailing Address
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Address Line | 867 COMMERCE DR SW STE 100
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City | CONYERS
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State | GA
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Zip | 30094-6604
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Country | US
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Telephone | 770-544-7643
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Fax | 770-679-4915
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Authorized Official
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Title or Position | CEO
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Name | CASSANDRA E. CONTON
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Credential | PH.D
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Telephone | 678-523-3592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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