MEDICARE: ANGEL'S CARE PERSONAL CARE HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1639039837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL'S CARE PERSONAL CARE HOME LLC

Provider Business Mailing Address
First Line	:	2620 RICHMOND HILL RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-2881
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 RICHMOND HILL RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-2881
Country	:	US
Telephone Number	:	706-504-8873
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGEL DUNN
Credential	:
Telephone Number	:	706-504-8873

Provider Enumeration Date	:	11/12/2025
Last Update Date	:	11/12/2025

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