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General NPI Number Information
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NPI Number | 1871610535
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Entity Type | Organization
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Legal Business Name | ANGELS OF MERCY PRIVATE HOMECARE SERVICES, INC.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 776 BACONSFIELD DR BLDG. 2 STE. 107
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City | MACON
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State | GA
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Zip | 31211-1492
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Country | US
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Telephone | 478-738-0095
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Fax | 478-738-0095
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Provider Business Mailing Address
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Address Line | 776 BACONSFIELD DR BLDG. 2 STE. 107
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City | MACON
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State | GA
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Zip | 31211-1492
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Country | US
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Telephone | 478-738-0095
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Fax | 478-738-0095
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Authorized Official
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Title or Position | NURSE MANAGER
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Name | ZANDREA JENEAN DURHAM
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Credential | R.N.
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Telephone | 478-738-0095
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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 | 011-R-0033
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License Number State | GA
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