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General NPI Number Information
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NPI Number | 1730373416
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Entity Type | Organization
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Legal Business Name | AMBASSADOR OF ANGELS INC.
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 3782 CITATION DR
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City | DECATUR
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State | GA
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Zip | 30034-2128
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Country | US
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Telephone | 770-909-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 1367 HIGHWAY 138 SW
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City | RIVERDALE
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State | GA
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Zip | 30296-1403
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Country | US
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Telephone | 770-909-7337
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Fax | 770-909-6211
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Authorized Official
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Title or Position | HEAD ADMINISTRATOR
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Name | BRIAN OWENS
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Credential |
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Telephone | 770-909-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | GA
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