=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700439627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL ANGEL CARE,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2019
-----------------------------------------------------
Last Update Date | 07/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2398 LENORA CHURCH RD STE 102
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-6921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-809-3777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2398 LENORA CHURCH RD STE 102
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-6921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-809-3777
-----------------------------------------------------
Fax | 770-809-3777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EVANDER DIKE SYLVANUS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-809-3777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------